Individual provider Active NPI

Mary Ann Ellis, DNP, APRN, CNP

  • Nurse Practitioner
  • Rochester, MN
National Provider Identifier
1699261610
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5943 Issued in MN
Practice address
5067 55TH St NW
Rochester, MN 55901-3809
Phone
(507) 292-7070
NPI assigned
Jul 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5943 MN Primary
Family Nurse Practitioner 363LF0000X 5943 MN

Addresses

Primary practice location

5067 55TH St NW
Rochester, MN 55901-3809

Mailing address

5067 55TH St NW
Rochester, MN 55901-3809
Phone (507) 292-7070

Other practice location 1

200 1st St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Other practice location 2

404 W Fountain St
Albert Lea, MN 56007-2437
Phone (262) 492-5156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180802003595 MN Practitioner - Nurse Practitioner 9739437070 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olmsted Medical CenterGroup PAC ID 8527970060, 324 clinicians

Practice addresses (Care Compare)

210 9TH St SE
Rochester, MN 55904-6425
Phone (507) 288-3443

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5943MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Current Accepting new patients
Mayo Clinic CurrentSince Feb 3, 2023 Accepting new patients
Mayo Clinic CurrentSince Feb 3, 2023 Accepting new patients
Ladd Memorial Hospital Past Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

210 9th St SE
Rochester, MN 55904
Phone (507) 529-6616

1650 4th St SE
Rochester, MN 55904
Phone (507) 285-8485

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1699261610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5067 55TH ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013809",
            "telephone_number": "507-292-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5067 55TH ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013809",
            "telephone_number": "507-292-7070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "404 W Fountain St",
            "address_purpose": "LOCATION",
            "city": "Albert Lea",
            "state": "MN",
            "postal_code": "560072437",
            "country_code": "US",
            "telephone_number": "262-492-5156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "DNP, APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-02",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "5943",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "5943",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.