Ellis Pediatrics, PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

ELLIS PEDIATRICS, PLLC

Practice address

12086 Fort Caroline Rd Ste 401
Jacksonville, FL 32225-7640

Phone

(904) 456-9240

NPI assigned

Oct 10, 2022

Organization subpart

No

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

Authorized official

Name

Kenyanita Ellis, DONPI 1841727716

Title

Owner/Pediatrician

Phone

(904) 456-9240

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 14

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

• Kenyanita Ellis, D.O.

  • Pediatrics Physician
  • Jacksonville, FL
  • NPI 1841727716
  Medicare reassignment NPD Authorized official
• Stephanie Nicole Burkhalter, ARNP

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1386027332
  NPD
• William Gonzalez, ARNP

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1467693358
  NPD
• James Augustus Joyner IV, M.D.

  • General Practice Physician
  • Jacksonville, FL
  • NPI 1265526602

  Pediatrics

  NPD
• Susan Lee

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1003230657
  NPD
• Kia Michon Mitchell, M.D.

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1184602583
  NPD
• Thanh M Nguyen, MD

  • Pediatric Endocrinology Physician
  • Jacksonville, FL
  • NPI 1831296656

  Pediatrics

  NPD
• Megan Finck, PA-C

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1730584673
  NPD (past)
• Jessica Alice Johnson, APRN

  • Nurse Practitioner
  • Jacksonville, FL
  • NPI 1952870644
  NPD (past)
• William Dewey Lee III, PA

  • Medical Physician Assistant
  • Jacksonville, FL
  • NPI 1356693881
  NPD (past)
• Kaitlin Ray, ARNP

  • Pediatric Nurse Practitioner
  • Jacksonville, FL
  • NPI 1518275254
  NPD (past)
• Tulin Emine Rogers, PA

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1184143554
  NPD (past)

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1134844426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12086 FORT CAROLINE RD STE 401",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322257640",
            "telephone_number": "904-456-9240",
            "fax_number": "904-456-9231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12086 FORT CAROLINE RD STE 401",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322257640",
            "telephone_number": "904-456-9240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-10",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "KENYANITA",
        "authorized_official_title_or_position": "OWNER/PEDIATRICIAN",
        "authorized_official_telephone_number": "904-456-9240",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Elliott, LMT, CNMT, BAS
• Michelle C Elliott, APRN
• Scott Elliott, BCAP, NCAC II
• Scott James Elliott, DDS
• William Rudolph Elliott, RPH
• Joni A. Ellis-Hughes, RN, BSN, CCRN, CRNI
• Ellis-Moore Coroporation
• Ellis-Moore Coroporation
• Ellis-Moore Corporation
• Bela Ellis

• Pediatrics Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.