Ethany Lea Cullen, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

51214 Issued in MN

Practice address

421 12TH St NW
Byron, MN 55920-1391

Phone

(952) 595-1100

Fax

(612) 294-4903

NPI assigned

Jul 3, 2007

Last updated

May 22, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, ND2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Diagnostic Radiology

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford BismarckGroup PAC ID 9739098575, 562 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanford Medical Center Bismarck Hospital, Bismarck, ND, CCN 350015
• McKenzie County Healthcare Systems Inc Hospital, Watford City, ND, CCN 351302
• CHI St Alexius Health Hospital, Bismarck, ND, CCN 350002
• Trinity Hospitals Hospital, Minot, ND, CCN 350006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sanford Bismarck

  dba Family Wellness

  • Multi-Specialty Clinic/Center
  • Bismarck, ND
  • NPI 1811941172

  MN

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• McKenzie County Healthcare Systems Inc

  • Critical Access Hospital
  • Watford City, ND
  • NPI 1518988948
  Care Compare affiliation
• Sanford Bismarck

  dba Sanford MRI Center

  • General Acute Care Hospital
  • Bismarck, ND
  • NPI 1538245634
  Care Compare affiliation
• St. Alexius Medical Center

  dba CHI St. Alexius Health

  • General Acute Care Hospital
  • Bismarck, ND
  • NPI 1306832654
  Care Compare affiliation
• Trinity Hospitals

  dba Trinity Health First Response Air Ambulance

  • Air Ambulance
  • Minot, ND
  • NPI 1053502773

  Hospital

  Care Compare affiliation
• Trinity Hospitals

  dba Community Ambulance Service, Inc.

  • Land Ambulance
  • Minot, ND
  • NPI 1134310857

  Hospital

  Care Compare affiliation
• Trinity Hospitals

  • General Acute Care Hospital
  • Minot, ND
  • NPI 1427103910
  Care Compare affiliation
• Trinity Hospitals

  dba Trinity Hospitals Residential Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Minot, ND
  • NPI 1457539660

  Hospital

  Care Compare affiliation
• Trinity Hospitals

  dba Trinity St Joseph's CDU

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Minot, ND
  • NPI 1487804092
  Care Compare affiliation
• Trinity Hospitals

  • General Acute Care Hospital
  • Minot, ND
  • NPI 1932359544
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400716800000",
    "number": "1679771497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN",
            "address_2": "STE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445347",
            "telephone_number": "952-595-1301",
            "fax_number": "612-294-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 12TH ST NW",
            "city": "BYRON",
            "state": "MN",
            "postal_code": "559201391",
            "telephone_number": "952-595-1100",
            "fax_number": "612-294-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "ETHANY",
        "middle_name": "LEA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2014-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "51214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Byron Chiropractic, Inc.
• Byron Dental Group PA
• Byron Eye Care
• Adilene Cazares
• Jennifer Helen Clement, MD
• Karen A Delacey
• Sara Dion
• Nakisha Dyson
• Sara Elizabeth Egan
• Gwendy Jo Ellingson

• Diagnostic Radiology Physician in Byron, MN
• Providers in Byron, MN by specialty
• Diagnostic Radiology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.