NPIMap

Organization Active NPI

Ellington Eyecare PLLC

  • Optometrist
  • North Platte, NE
National Provider Identifier
1093533796
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ELLINGTON EYECARE PLLC
Practice address
1401 S Dewey St
North Platte, NE 69101-7622
Phone
(308) 532-0220
NPI assigned
Oct 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Authorized official

Name
Jacqueline Carmen Elizabeth EvansNPI 1053726315
Title
Ceo
Phone
(303) 445-9446

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1401 S Dewey St
North Platte, NE 69101-7622

Mailing address

4875 S Jason St
Englewood, CO 80110-6414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220601002370 NE Part B Supplier - Clinic/Group Practice 3072918754 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: MC Cook, NE; North Platte, NE

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ellington Eyecare PLLC33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1727740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1093533796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4875 S JASON ST",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801106414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S DEWEY ST",
            "city": "NORTH PLATTE",
            "state": "NE",
            "postal_code": "691017622",
            "telephone_number": "308-532-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLINGTON EYECARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-01",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "CARMEN ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "303-445-9446"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Platte, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.