GARY EARL ELLWEIN MD
NPI 1063480804
Pathology - Anatomic Pathology & Clinical Pathology in Idaho Falls, ID

Q: What is Gary Ellwein's NPI number?

The NPI number for Gary Ellwein is 1063480804. It was assigned to this individual provider in the NPPES registry on March 9, 2006.

Q: What is Gary Ellwein's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.

Q: When was this NPI record last updated?

The NPPES record for Gary Ellwein was last updated on December 27, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 09, 2006PECOS Enrolled

3100 CHANNING WAY, IDAHO FALLS, ID 83404(208) 529-6050(208) 529-7085 Get Directions Write a Review

NPPES record last updated: December 27, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Gary Earl Ellwein Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GARY EARL ELLWEIN MD (NPI 1063480804) is an individual anatomic pathology & clinical pathology provider in Idaho Falls, Idaho, licensed in Idaho (M3265) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063480804

Entity TypeIndividualMale

Primary Taxonomy207ZP0102X

Provider Legal NameGARY EARL ELLWEINCredential: MD

Location Address3100 CHANNING WAYIdaho Falls, ID 83404-7533

Mailing Address1820 E 17th St, Ste 230Idaho Falls, ID 83404-6521 · (208) 529-9779 · Fax (208) 542-2756

Phone(208) 529-6050

Fax(208) 529-7085

Sole ProprietorNo

Enumeration DateMarch 9, 2006

Last NPPES UpdateDecember 27, 2012

✔ NPI 1063480804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians

Taxonomy Code207ZP0102X

License✔ Licensed in ID · M3265

Definition

A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.

3100 CHANNING WAY, Idaho Falls, ID 83404

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Other Identifiers 5

Other000010003940ID · Regence Blue Shield Of Id

Other32625ID · Blue Cross Of Idaho

Medicaid003682000ID

Medicare UPIND93348ID

Medicare PIN1121828ID

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gary Earl Ellwein Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83404 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$121.27 typical visit price

range $52.44 – $160.17

Typical copayment $30.31 (range $13.11 – $40.04)

Most-billed visit code 99204

Established Patient

$93.26 typical visit price

range $16.68 – $130.93

Typical copayment $23.31 (range $4.17 – $32.73)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CARL SAMUEL BRAYTON DO

Student in an Organized Health Care Education/Training Program