Robert E Ellis MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

19194 Issued in KY

Legal business name

ROBERT E ELLIS MD

Practice address

9115 Leesgate Rd
Suite C
Louisville, KY 40222-5003

Phone

(502) 719-0782

Fax

(502) 719-0787

NPI assigned

Feb 20, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Robert E Ellis, M.D.NPI 1427006816

Title

President

Phone

(502) 719-0782

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

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 2

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

• Robert Ellsworth Ellis, M.D.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1427006816

  Internal Medicine, KY

  Medicare reassignment NPD Authorized official
• Garrett M Crabtree, M.D.

  • Dermatology Physician
  • Louisville, KY
  • NPI 1407972060
  NPD (past)

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250121600000",
    "number": "1154465276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9115 LEESGATE RD",
            "address_2": "SUITE C",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225003",
            "telephone_number": "502-719-0782",
            "fax_number": "502-719-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9115 LEESGATE RD",
            "address_2": "SUITE C",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225003",
            "telephone_number": "502-719-0782",
            "fax_number": "502-719-0787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT E ELLIS MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2009-08-13",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-719-0782",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "19194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT HEALTH PLAN",
            "identifier": "1172028",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2441036000",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CH0800",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lenice Roberson, CPT
• Lynn Allan Roberson, LMT
• Megan Marie Roberson, LCSW
• Molly Roberson, PA
• Robert B. Nolan, Jr., MD, PLLC
• Robert E Emig D C PLLC
• Robert E. Emig DC PLLC
• Robert G Hammer MD & Associates
• Robert H. Stewart, MD PSC
• Robert J. Homm, MD, PSC

• All providers in Louisville, KY
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2009; 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.