John W Emblom, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

27767 Issued in MN

Practice address

610 30TH Avenue West
Alexandria Clinic
Alexandria, MN 56308

Phone

(320) 763-5123

Fax

(320) 763-7883

NPI assigned

Jan 20, 2006

Last updated

Aug 9, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• West Central Pathology and Laboratory Medicine PA

  • Clinical Medical Laboratory
  • Alexandria, MN
  • NPI 1811988025
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376006400000",
    "number": "1982684395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 30TH AVENUE WEST",
            "address_2": "ALEXANDRIA CLINIC",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 30TH AVENUE WEST",
            "address_2": "ALEXANDRIA CLINIC",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMBLOM",
        "first_name": "JOHN",
        "middle_name": "W",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2013-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "27767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "698393600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110163853",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ritajo Ellenberger
• David Michael Ellis, CPO
• Tim D Ellison
• Marcine P Ellwein, M.D.
• Tiffany Marie Emard
• Brittany Emons
• Empowered Midwifery and Wellness, LLC
• Resada Kathryn Enberg, PT, DPT, ATC
• Renae Suzanne Endres
• Lauren Englund

• Internal Medicine Physician in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.