Tesfatsiyon Mammo Ergando, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Minneapolis, Minnesota. His current practice location is
420 Delaware Street Se, Mmc 284, Minneapolis, Minnesota. You can reach out to his office (for appointments etc.) via phone at
(612) 626-5454.
Tesfatsiyon Mammo Ergando is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1043884224.
Physician's Profile
Full Name | Tesfatsiyon Mammo Ergando |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 420 Delaware Street Se, Mmc 284, Minneapolis, Minnesota |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1043884224
- Provider Enumeration Date: 05/13/2021
- Last Update Date: 11/01/2022
Medicare PECOS Information:
- PECOS PAC ID: 2163822305
- Enrollment ID: I20221228002930
Medical Identifiers
Medical identifiers for Tesfatsiyon Mammo Ergando such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1043884224 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207R00000X | Internal Medicine | 72769 (Minnesota) | Secondary |
208D00000X | General Practice | 72769 (Minnesota) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Tesfatsiyon Mammo Ergando allows following entities to bill medicare on his behalf.
Entity Name | Unity Family Healthcare |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1326234006 PECOS PAC ID: 9830003516 Enrollment ID: O20031117000732 |
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Entity Name | Community Memorial Hospital Association |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1003869082 PECOS PAC ID: 0042129991 Enrollment ID: O20040202001203 |
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Entity Name | Unity Family Healthcare |
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Entity Type | Part A Provider - Critical Access Hospital |
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Entity Identifiers | NPI Number: 1780630939 PECOS PAC ID: 9830003516 Enrollment ID: O20061104000248 |
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Entity Name | Signify Health Medical Associates Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1750845863 PECOS PAC ID: 2163764424 Enrollment ID: O20200116002549 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tesfatsiyon Mammo Ergando is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Tesfatsiyon Mammo Ergando, MD 420 Delaware Street Se, Mmc 284, Minneapolis, MN 55455 Ph: (612) 626-5454 | Tesfatsiyon Mammo Ergando, MD 420 Delaware Street Se, Mmc 284, Minneapolis, MN 55455 Ph: (612) 626-5454 |
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