Active NPI
Joanne K Eller, PA
- Physician Assistant
- Stillwater, MN
National Provider Identifier
1811962863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 9384
- Practice address
- 1500 Curve Crest Blvd W
Stillwater, MN 55082-6040 - Phone
- (651) 439-1234
- Fax
- (651) 275-3325
- NPI assigned
- Feb 22, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9384 | MN | Primary |
Addresses
Primary practice location
1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Mailing address
8170 33Rd Ave S
Minneapolis, MN 55425-4516
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 998113600 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9384 | MN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615852800000",
"number": "1811962863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8170 33RD AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554254516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 CURVE CREST BLVD W",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826040",
"telephone_number": "651-439-1234",
"fax_number": "651-275-3325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLER",
"first_name": "JOANNE",
"middle_name": "K",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-22",
"last_updated": "2021-03-16",
"certification_date": "2021-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "9384",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "998113600",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stillwater, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.