Robert William Ellis III, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

4301097679 Issued in MI

Practice address

204 W Grand River Ave
Suite 260
Howell, MI 48843-2299

Phone

(517) 545-1010

Fax

(517) 545-1025

NPI assigned

Jan 5, 2006

Sex

Male

Sole proprietor

Yes

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 MI

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

Psychiatry

Education

Wayne State University School of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Livingston County Catholic CharitiesGroup PAC ID 8527972223, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Livingston County Catholic Charities

  • Mental Health Counselor
  • Howell, MI
  • NPI 1801904594
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339200000000",
    "number": "1124006549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 W GRAND RIVER AVE",
            "address_2": "SUITE 260",
            "city": "HOWELL",
            "state": "MI",
            "postal_code": "488432299",
            "telephone_number": "517-545-1010",
            "fax_number": "517-545-1025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W GRAND RIVER AVE",
            "address_2": "SUITE 260",
            "city": "HOWELL",
            "state": "MI",
            "postal_code": "488432299",
            "telephone_number": "517-545-1010",
            "fax_number": "517-545-1025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2012-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MI",
            "license": "4301097679",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301097679",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Marian-Henderson Egan, MS, PA-C
• Stephanie Renee Eggleston
• Nicole R Ehinger, NP-C
• Rachel C Ehlfeldt, LMSW
• Elizabeth Baise-Bergeron, D.C., P.C.
• Jennifer Ellsworth, RN
• Elizabeth Elsner
• Katherine Elwell
• Emerge and Evolve Therapy PLLC
• Gary Scott Emmerich

• Child & Adolescent Psychiatry Physician in Howell, MI
• Providers in Howell, MI by specialty
• Child & Adolescent Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2012; 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.