Jesse Ellsworth

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

4301106067 Issued in MI

Practice address

1000 Houghton Ave
Saginaw, MI 48602-5303

Phone

(989) 583-6800

NPI assigned

Jun 23, 2014

Last updated

Jun 23, 2014By the provider in NPPES

Sex

Male

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

Enrolled in NC, HI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Emergency Medicine

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Kernersville Emergency Group, PLLCGroup PAC ID 3375885429, 53 clinicians

The Makana North Shore ClinicGroup PAC ID 8426308883, 27 clinicians

Tanglewood Park Physicians PLLCGroup PAC ID 3476895129, 47 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Merit-based Incentive Payment System (MIPS)

Final score

97.86 of 100Reported as group

Quality

97.48

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

89.09 of 100Reported as group

Quality

84.49

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

86.5 of 100Reported as group

Quality

84.11

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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

• Kernersville Emergency Group, PLLC

  • Emergency Medicine Physician
  • Kernersville, NC
  • NPI 1750852034
  Medicare reassignment Care Compare group NPD
• Tanglewood Park Physicians, PLLC

  • Emergency Medicine Physician
  • Clemmons, NC
  • NPI 1093286379
  Medicare reassignment Care Compare group NPD
• The Makana North Shore Clinic

  dba Makana North Shore Urgent Care

  • Urgent Care Clinic/Center
  • Princeville, HI
  • NPI 1114431632
  Medicare reassignment Care Compare group NPD
• Brunswick Physician Partners, PLLC

  • Emergency Medicine Physician
  • Bolivia, NC
  • NPI 1457822264
  Medicare reassignment NPD
• Gastonia Physician Services, PLLC

  • Emergency Medicine Physician
  • Gastonia, NC
  • NPI 1316367691
  Medicare reassignment NPD
• Piedmont Triad Physicians, PLLC

  • Emergency Medicine Physician
  • Thomasville, NC
  • NPI 1295206464
  Medicare reassignment NPD
• Gastonia Physician Services, PLLC

  • Emergency Medicine Physician
  • Belmont, NC
  • NPI 1104644004
  NPD

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

• Forsyth Memorial Hospital, Inc.

  dba Novant Health Forsyth Medical Center

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1063827582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HOUGHTON AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486025303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HOUGHTON AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486025303",
            "telephone_number": "989-583-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "JESSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301106067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Leigh Ellis, LBSW
• Kayley Ellis
• Kelly Ellis, NURSE PRACTITIONER
• Silisia Ellis
• Katelyn Ellison
• Assem Ellythy, M.D
• Aveeance Elmore
• Osama M Elsabagh, M.D.
• Brooklyn Elsea
• Daniel Elsholz, MD

• Emergency Medicine Physician in Saginaw, MI
• Providers in Saginaw, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.