NPIMap

Individual provider Active NPI

Crystal Mann-Ellis, NP

  • Family Nurse Practitioner
  • Henrico, VA
National Provider Identifier
1124567581
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024174547 Issued in VA
Practice address
1504 Santa Rosa Rd RM 114
Henrico, VA 23229-5109
Phone
(804) 210-3103
Fax
(804) 210-3104
NPI assigned
Feb 18, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024174547 VA Primary

Addresses

Primary practice location

1504 Santa Rosa Rd RM 114
Henrico, VA 23229-5109

Mailing address

1504 Santa Rosa Rd RM 114
Henrico, VA 23229-5109
Phone (804) 210-3101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20170418002543 VA Practitioner - Nurse Practitioner 9638455157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Harmony at Home Provider Services LLCGroup PAC ID 4587030804, 25 clinicians

Practice addresses (Care Compare)

1504 Santa Rosa Rd
RM 116
Henrico, VA 23229-5109
Phone (804) 210-3103

Hospital & facility affiliations

  • Welcome Homecare Home health agency, Richmond, VA, CCN 497455
  • James River Home Health Agency Home health agency, Richmond, VA, CCN 497706
  • At Home Care Home health agency, Mechanicsvlle, VA, CCN 497493
  • Centerwell Home Health Home health agency, Richmond, VA, CCN 497424
  • Amedisys Home Health Home health agency, Midlothian, VA, CCN 497538

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024174547VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Harmony at Home Provider Services LLC CurrentSince Jul 15, 2024 Accepting new patients
WFS Home Care Enterprises, Inc. Dba at Home Harmony Pharmacy LTC CurrentSince Jul 15, 2024 Accepting new patients

Locations

1504 Santa Rosa Rd
Rm 116
Henrico, VA 23229
Phone (804) 210-3103

1504 Santa Rosa Rd
Rm 114
Richmond, VA 23229
Phone (804) 210-3103

Interoperability endpoints

  • Direct secure messaging: crystal.mann-ellis.1@26346.direct.athenahealth.com

Organizations & group practices 2

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1487376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1124567581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 SANTA ROSA RD RM 114",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232295109",
            "telephone_number": "804-210-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 SANTA ROSA RD RM 114",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232295109",
            "telephone_number": "804-210-3103",
            "fax_number": "804-210-3104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANN-ELLIS",
        "first_name": "CRYSTAL",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-18",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024174547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henrico, VA

Sources for this page

Verify at the official NPI Registry.