Active NPI
Ellie Hagen
- Physical Medicine & Rehabilitation Physician
- Fargo, ND
National Provider Identifier
1740957943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 2570
- Practice address
- 737 Broadway N
Fargo, ND 58102-4421 - Phone
- (701) 234-5932
- NPI assigned
- Aug 25, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 2570 | ND | Primary |
Addresses
Primary practice location
737 Broadway N
Fargo, ND 58102-4421
Mailing address
737 Broadway N
Fargo, ND 58102-4421
Phone (701) 234-5932
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 |
|---|---|---|---|
| 2570 | ND | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629849600000",
"number": "1740957943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "737 BROADWAY N",
"city": "FARGO",
"state": "ND",
"postal_code": "581024421",
"telephone_number": "701-234-5932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "737 BROADWAY N",
"city": "FARGO",
"state": "ND",
"postal_code": "581024421",
"telephone_number": "701-234-5932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEN",
"first_name": "ELLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-25",
"last_updated": "2021-08-25",
"certification_date": "2021-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "ND",
"license": "2570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.