NPIMap

Individual provider Active NPI

Amanda Susan Ellington, MD

  • Surgery Physician
  • Lake Charles, LA
National Provider Identifier
1023219110
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
203251 Issued in LA
Practice address
2770 3Rd Ave Ste 120
Lake Charles, LA 70601-8994
Phone
(337) 494-4868
Fax
(337) 494-4870
NPI assigned
May 29, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 203251 LA Primary

Addresses

Primary practice location

2770 3Rd Ave Ste 120
Lake Charles, LA 70601-8994

Mailing address

P.O. Box 122342 Dept 2342
Lake Charles, LA 70601
Phone (337) 494-2921

Other identifiers 2

IdentifierTypeStateIssuer
1099791MedicaidLA
MD.203251OtherLASTATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120911000207 LA Practitioner - General Surgery 0840448213 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Louisiana State University School of Medicine in Shreveport, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
LCMS Surgical Associates of Southwest Lousiana, LLCGroup PAC ID 8820113780, 7 clinicians

Practice addresses (Care Compare)

2770 3Rd Ave
Suite 120
Lake Charles, LA 70601-8994
Phone (337) 494-4868

Hospital & facility affiliations

  • Southern Home Health Home health agency, Lake Charles, LA, CCN 197766
  • Beauregard Home Health Home health agency, Deridder, LA, CCN 197183
  • Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060
  • Christus Ochsner Lake Area Hospital Hospital, Lake Charles, LA, CCN 190201
  • Beauregard Memorial Hospital Hospital, Deridder, LA, CCN 190050
  • Christus Ochsner St Patrick Hospital Hospital, Lake Charles, LA, CCN 190027
  • Ochsner American Legion Hospital Hospital, Jennings, LA, CCN 190053

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Mastectomy60
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Hospital Management System LLC Surgery CurrentSince Feb 1, 2014 Accepting new patients
LCMS Surgical Associates of Southwest Lousiana, LLC Surgery CurrentSince Aug 1, 2017 Accepting new patients
Lsuhn Billing LLC CurrentSince Jul 1, 2017 Accepting new patients
Lsuhn Billing LLC CurrentSince Jul 1, 2017 Accepting new patients

Locations

1634 Elton Rd
Jennings, LA 70546
Phone (337) 616-7000

2390 W Congress St
Lafayette, LA 70506
Phone (337) 261-6000

1214 Coolidge Blvd
Lafayette, LA 70503
Phone (337) 234-9191

1000 W Pinhook Rd
Ste 310
Lafayette, LA 70503
Phone (337) 233-9900

2770 3rd Ave
Ste 120
Lake Charles, LA 70601
Phone (337) 494-4868

Networks

  • MS PPO C-SNP
  • MS PPO
  • MS PPO D-SNP

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24793/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lake Charles Memorial HospitalLake Charles, LA, CCN 19T060 Hospital Corporate Officer Jan 1, 2022
Lake Charles Memorial HospitalLake Charles, LA, CCN 19S060 Hospital Corporate Officer Jan 1, 2022
Home Health Agency of Lake Charles Memorial HospitalLake Charles, LA, CCN 197005 Home health agency Corporate Officer Jan 1, 2022
Iowa Health CenterIowa, LA, CCN 193408 Rural health clinic Corporate Officer Jan 1, 2022

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1023219110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 122342 DEPT 2342",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "70601",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 3RD AVE STE 120",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018994",
            "telephone_number": "337-494-4868",
            "fax_number": "337-494-4870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGTON",
        "first_name": "AMANDA",
        "middle_name": "SUSAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "203251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1099791",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "MD.203251",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.