Active NPI
Edward Joseph McEllistrem
- Family Medicine Physician
- West St Paul, MN
National Provider Identifier
1699350462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 15877
- Practice address
- 888 Christensen Ave
West St Paul, MN 55118-1633 - Phone
- (651) 457-1034
- NPI assigned
- Mar 13, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 15877 | MN | Primary |
Addresses
Primary practice location
888 Christensen Ave
West St Paul, MN 55118-1633
Mailing address
888 Christensen Ave
West St Paul, MN 55118-1633
Phone (651) 457-1034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15877 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615593600000",
"number": "1699350462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "888 CHRISTENSEN AVE",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551181633",
"telephone_number": "651-457-1034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "888 CHRISTENSEN AVE",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551181633",
"telephone_number": "651-457-1034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCELLISTREM",
"first_name": "EDWARD",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-13",
"last_updated": "2021-03-13",
"certification_date": "2021-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "15877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West St Paul, MN
- Greg B Markeson, OD
- Whitney Jenelle Markson, DPT
- Marlu Health LLC
- Kara Theresa Marriott, LICSW
- Courtney Elizabeth Mathias
- Kelsi McEnaney, DDS
- Meghan McKusky, MS CCC-SLP
- Jessica Rose McRae
- Medexpress Urgent Care Minnesota P.C. (MedExpress Urgent Care - West St Paul, Robert St S)
- Mendakota Pediatrics LTD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.