Individual provider Active NPI

Ellen C Thompson, APRN

  • Family Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1770831067
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
6840 Issued in MN
Practice address
525 Portland Ave # Mc963
Minneapolis, MN 55415
Phone
(612) 348-5553
NPI assigned
Aug 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 05082 CT
Family Nurse Practitioner 363LF0000X F340561-1 NY
Family Nurse Practitioner 363LF0000X 6840 MN Primary

Addresses

Primary practice location

525 Portland Ave # Mc963
Minneapolis, MN 55415

Mailing address

525 Portland Ave # Mc963
Minneapolis, MN 55415-1533
Phone (612) 348-5553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180511001413 NY Practitioner - Nurse Practitioner 2365694353 Reassigns benefits to 1 organization
I20191114000995 MN Practitioner - Nurse Practitioner 2365694353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin CountyGroup PAC ID 7911892849, 132 clinicians

Practice addresses (Care Compare)

1010 Currie Ave
Minneapolis, MN 55403-1309
Phone (612) 348-5553

525 Portland Ave
Minneapolis, MN 55415-1569

525 Portland Ave S MC
Minneapolis, MN 55415-1569

614 S 3Rd St
Minneapolis, MN 55415-1104
Phone (612) 348-5553

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6840MNMDPhysical Therapist
5082CTMDOccupational Therapist
05082CTMDFamily Nurse Practitioner
F340561-1NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin County CurrentSince Nov 12, 2019 Accepting new patients
Hennepin County Current Accepting new patients
Hennepin County CurrentSince Nov 12, 2019 Accepting new patients
Coordinated Behavioral Care Ipa Inc PastSince Feb 26, 2018 Accepting new patients

Locations

525 Portland Ave
#963
Minneapolis, MN 55415
Phone (612) 348-2233

525 Portland Ave
Minneapolis, MN 55415
Phone (612) 348-8824

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": "1345161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1770831067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE # MC963",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151533",
            "telephone_number": "612-348-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE # MC963",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55415",
            "telephone_number": "612-348-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "ELLEN",
        "middle_name": "C",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-17",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "05082",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F340561-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "6840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.