NPIMap

Individual provider Active NPI

Thomasena L Ellison, MD FACOG

  • Obstetrics & Gynecology Physician
  • Brooklyn, NY
National Provider Identifier
1114000403
Registry record updated Jul 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
1802491 Issued in NY
Practice address
100 Livingston Street
3Rd Floor
Brooklyn, NY 11201
Phone
(718) 222-0393
Fax
(718) 222-3653
NPI assigned
Oct 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 1802491 NY Primary

Addresses

Primary practice location

100 Livingston Street
3Rd Floor
Brooklyn, NY 11201

Mailing address

100 Livingston Street
3Rd Floor
Brooklyn, NY 11201
Phone (718) 222-0393

Other identifiers 9

IdentifierTypeStateIssuer
ET0249OtherATLANTIS
N323923OtherWELL CARE
0202017OtherGHI
112619613EL02OtherCARE PLUS
3C1694OtherHEALTHNET
P406658OtherOXFORD
30310POtherHIP
T4XOtherETIN
255780401OtherHEALTH PLUS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110112000484 NY Practitioner - Obstetrics/Gynecology 4385833011 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Morehouse School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MMC OB/GYN Faculty Practice PlanGroup PAC ID 0345274809, 31 clinicians

Practice addresses (Care Compare)

4802 10TH Ave
Brooklyn, NY 11219-2916
Phone (718) 283-8225

Hospital & facility affiliations

  • Maimonides Medical Center Hospital, Brooklyn, NY, CCN 330194
  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214
  • New York-Presbyterian Hospital Hospital, New York, NY, CCN 330101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1802491NYMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Faculty Practice Plan CurrentSince Dec 30, 2018 Accepting new patients
Maimonides Medical Center Current Accepting new patients
MMC OB-GYN Faculty Practice Plan CurrentSince Dec 30, 2018 Accepting new patients
MMC OB/GYN Hospital Past Accepting new patients

Locations

4422 9th Ave
#1
Brooklyn, NY 11220

550 5th Ave
Ste B
Brooklyn, NY 11215

4422 9th Ave
Brooklyn, NY 11220
Phone (718) 283-8930

1616A Voorhies Ave
Brooklyn, NY 11235
Phone (718) 283-8225

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

100 Livingston St
Fl 3
Brooklyn, NY 11201
Phone (718) 222-0393

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: thomasenaellison@mai.allscriptsdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404259200000",
    "number": "1114000403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LIVINGSTON STREET",
            "address_2": "3RD FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11201",
            "telephone_number": "718-222-0393",
            "fax_number": "718-222-3653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LIVINGSTON STREET",
            "address_2": "3RD FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11201",
            "telephone_number": "718-222-0393",
            "fax_number": "718-222-3653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "THOMASENA",
        "middle_name": "L",
        "credential": "MD FACOG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2014-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "1802491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATLANTIS",
            "identifier": "ET0249",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELL CARE",
            "identifier": "N323923",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0202017",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE PLUS",
            "identifier": "112619613EL02",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "3C1694",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P406658",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "30310P",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ETIN",
            "identifier": "T4X",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS",
            "identifier": "255780401",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.