Robert G Ellison, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD04969 Issued in RI

Practice address

400 Bald Hill Rd
Ste 520
Warwick, RI 02886-1692

Phone

(401) 793-8520

Fax

(401) 793-8527

NPI assigned

Jun 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189123200000",
    "number": "1083610836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 BALD HILL RD",
            "address_2": "STE 520",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028861692",
            "telephone_number": "401-793-8520",
            "fax_number": "401-793-8527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 BALD HILL RD",
            "address_2": "STE 520",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028861692",
            "telephone_number": "401-793-8520",
            "fax_number": "401-793-8527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "ROBERT",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2007-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD04969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RE04322",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2071151",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Warwick, RI
• Providers in Warwick, RI by specialty
• Internal Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.

Verify at the official NPI Registry.