Ellie Marie Bentley, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036150570 Issued in IL

Practice address

220 S Park Ave FL 3
Herrin, IL 62948

Phone

(618) 942-2002

Fax

(618) 351-6497

NPI assigned

Jul 28, 2013

Last updated

Sep 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

General Surgery

Education

Lake Erie College of Osteopathic Medicine, Erie, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Vohra Wound Physicians of Il SCGroup PAC ID 9830377688, 20 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ebentley28214@sih.direct-ci.com
• FHIR API: https://api.platform.athenahealth.com/2474/brand/3/csg/81/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.

• Vohra Wound Physicians of Il, S.C.

  • Family Medicine Physician
  • Arlington Heights, IL
  • NPI 1790080505

  Surgery

  Medicare reassignment Care Compare group NPD
• Southern Illinois Medical Services, NFP

  dba SIH Medical Group

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  Medicare reassignment NPD

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

{
    "created_epoch": "1374969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1093157315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S PARK AVE FL 3",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-942-2002",
            "fax_number": "618-351-6497"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Dr",
            "address_2": "Suite 162",
            "address_purpose": "LOCATION",
            "city": "Stratford",
            "state": "NJ",
            "postal_code": "080841500",
            "country_code": "US",
            "telephone_number": "856-566-6708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENTLEY",
        "first_name": "ELLIE",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-28",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036150570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebentley28214@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "220 S Park Ave Fl 3",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Serena Marie Belobraydic, MSN, APRN, FNP-C
• Aimee Belt, APN
• Sheila R. Beltz, LCSW
• Nikki Lee Benedict, CRNA
• Sharmisha Benjamin
• Kristin Rae Betz, NP
• Levite Judah Biddle, PARAMEDIC
• Ryleigh Morgan Billingsley, RBT
• Karla Annette Blake, DT
• Bradley Joseph Blakey, CRNA

• Surgery Physician in Herrin, IL
• Providers in Herrin, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; 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.