Ellis Travers, CCHW

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

20215 Issued in PA

Practice address

1348 Bainbridge St
Philadelphia, PA 19147-1810

Phone

(215) 563-0658

Fax

(877) 316-4122

NPI assigned

Sep 27, 2024

Sex

Unspecified or another gender identity

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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 and National Provider Directory roles.

• Mazzoni Center

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1477631307
  NPD

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

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1033937149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1348 BAINBRIDGE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471810",
            "telephone_number": "215-563-0658",
            "fax_number": "877-316-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1348 BAINBRIDGE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471810",
            "telephone_number": "215-563-0658",
            "fax_number": "877-316-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVERS",
        "first_name": "ELLIS",
        "credential": "CCHW",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "PA",
            "license": "20215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Trautz Shumsky, RPH
• Amy Travaline, CRNP
• John Travaline, MD
• Christopher Smith Travers, MD
• Eleanor May Travers, M.D.
• Latifah Fatima Travis-Bey, MS
• Zakia Malikah Travis-Bey, BS
• Martina Marie Travis
• Diane M. Travlos, APN
• Jacqueline N Travwick, LSW

• Community Health Worker in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Community Health Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.