Active NPI
Rita Ann Ellsworth, MD
- Pediatrics Physician
- Pueblo, CO
National Provider Identifier
1023077484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 23208
- Practice address
- 3676 Parker Blvd
Pueblo, CO 81008-2212 - Phone
- (719) 553-2200
- Fax
- (719) 553-2216
- NPI assigned
- Mar 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 23208 | CO | Primary |
Addresses
Primary practice location
3676 Parker Blvd
Pueblo, CO 81008-2212
Mailing address
PO Box 9000
Pueblo, CO 81008-9000
Phone (719) 553-1802
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01232081 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23208 | CO | MD | Pharmacist |
Interoperability endpoints
- https://api.platform.athenahealth.com/21306/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023077484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9000",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810089000",
"telephone_number": "719-553-1802",
"fax_number": "719-553-2216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3676 PARKER BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082212",
"telephone_number": "719-553-2200",
"fax_number": "719-553-2216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLSWORTH",
"first_name": "RITA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CO",
"license": "23208",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01232081",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.