Ely-Bloomenson Community Hospital
Organization Active NPI Community/Retail Pharmacy · Ely, MN
NPI 1972539658 · NPPES record last updated Jun 18, 2025
Key facts
- NPI
- 1972539658
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 262191 (MN)
- Legal business name
- ELY-BLOOMENSON COMMUNITY HOSPITAL
- Practice address
- 328 W Conan St
Ely, MN 55731-1145 - Phone
- (218) 365-8788
- Fax
- (218) 365-8789
- NPI assigned
- Jun 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Patricia Banks
- Title
- Ceo
- Phone
- (218) 356-8765
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 3
Practitioners 25
-
Christian T Cavalier, CRNA
-
Paul C Allegra, MD
-
Daniel P Dewey, MD
-
Katie R Evans, D.P.M.
-
Adam Tanner Hermes, PA-C
-
Julie Dawn Houle, MD
-
David Lloyd Johnson, CRNA
-
Matthew J Risken, MD
-
Lincoln R Roth, CRNA
-
Stephen Monroe Turner, D.O.
-
Lee Thomas Church, M.D.
-
Kristi Leigh Dreyer, D.O.
-
Robert Hubers, MD
-
Fritz Leidig, M.D.
-
Brittni McLam, DO
-
Joseph I Novik, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Health Dimensions Group |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Sep 30, 2011 Sep 30, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161005000718 | MN | DME Supplier - Pharmacy | 0042200040 | Practice locations: Ely, MN |
| O20250930000693 | MN | Part B Supplier - Pharmacy | 0042200040 | Practice locations: Ely, MN |
National Provider Directory
- Tax ID family
- Emergency RM Physicians
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 262191 | MN | Yes |
Addresses
Primary practice location
328 W Conan St
Ely, MN 55731-1145
Mailing address
328 W Conan St
Ely, MN 55731-1145
Phone (218) 365-8788
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 218238600 | Medicaid | MN | |
| 2048324 | Other | PK |
Other names
- ELY COMMUNITY PHARMACY
Other providers in Ely, MN
- Ely Family Dentistry
- Ely Vision - Optometry Center P.C.
- Ely-Bloomenson Community Hospital
- Ely-Bloomenson Community Hospital
- Ely-Bloomenson Community Hospital
- Essentia Health Virginia, LLC
- Essentia Health Virginia, LLC
- Sara Ann Fetyko
- Kim Noreen Garrett
- Healthy Families Chiropractic PLLC
All providers in Ely, MN · Community/Retail Pharmacy 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 18, 2025. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.