Eric Elleby
Individual provider Active NPI Family Medicine Physician · Cook, MN
NPI 1942629787 · NPPES record last updated Jun 30, 2021
Key facts
- NPI
- 1942629787
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 62672 (MN)
- Practice address
- 20 5TH St SE
Cook, MN 55723-9702 - Phone
- (218) 666-5941
- NPI assigned
- Apr 9, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cook Area Health Services, Inc
Practice addresses (Care Compare)
20 5TH St SE
Cook, MN 55723-9702
Phone (218) 666-5941
Hospital & facility affiliations
- Aveanna Home Health
- Moments Hospice
- Cook Hospital
- Range Regional Health Services
- Essentia Health St Mary'S Medical Center
- Essentia Health Virginia
- Cook Hospital
- Cook Hospital & Care Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170918002628 | MN | Practitioner - Family Practice | 0840507547 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62672 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook Area Health Services, Inc | Current | Accepting new patients | |
| Cook Area Health Services, Inc | Current | Accepting new patients | |
| Cook Area Health Services, Inc | Current |
Accepting new patients | |
| Cook Area Health Services, Inc | Current |
Accepting new patients |
Locations
135 Pine Tree Dr
Bigfork, MN 56628
Phone (218) 743-3232
20 5th St SE
Cook, MN 55723
Phone (218) 666-5941
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 62672 | MN | Yes |
Addresses
Primary practice location
20 5TH St SE
Cook, MN 55723-9702
Mailing address
20 5TH St SE
Cook, MN 55723-9702
Phone (218) 666-5941
Other practice location 1
815 10th St S
LA Crosse, WI 54601-4764
Phone (608) 392-7390
Other practice location 2
191 Theater Rd
Onalaska, WI 54650-8679
Phone (171) 583-8363
Other providers in Cook, MN
- Cook Hospital
- Cook Hospital Pharmacy
- Kaycee Mae Danielson
- Brittany Ann Debeltz
- Lynne M Didrikson I
- Franks Pharmacy Inc
- Bruce David Garbisch
- Kelli Hansen
- Ida B Haxton
- Bradley Scott Horoshak
All providers in Cook, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.