Carolyn Ellis

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2879 Issued in TN

Practice address

1904 Highway 46 S
Suite 3
Dickson, TN 37055-7744

Phone

(615) 375-8469

NPI assigned

Dec 10, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• App of Tennessee Ed, PLLC

  • Emergency Medicine Physician
  • Maryville, TN
  • NPI 1003230236
  Medicare reassignment
• Tonya Sue Davis, APRN-BC

  • Nurse Practitioner
  • Dickson, TN
  • NPI 1790705838
  Medicare reassignment
• Middle Tennessee Emergency Physicians PC

  • Emergency Medicine Physician
  • Nashville, TN
  • NPI 1194758979
  Medicare reassignment

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449705600000",
    "number": "1104291533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2203 SANDRA DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372105031",
            "telephone_number": "865-406-2396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 HIGHWAY 46 S",
            "address_2": "SUITE 3",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370557744",
            "telephone_number": "615-375-8469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CAROLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-10",
        "last_updated": "2015-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "2879",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "1087",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Hills Dental Center PLLC
• Jenna Claire Eggleton, NP
• Imudia Dekonte Ehanire, MD
• Elite Psychiatry of Tennessee LLC
• Andrea Elyse Ellington, M.S. CF-SLP
• Anna Lynn Epley, CHPT
• Lacey Erranton
• Kelly Estes, COTA
• Lori Ann Eubank, M.D.
• Evernorth Direct Health LLC

• Medical Physician Assistant in Dickson, TN
• Providers in Dickson, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.