Nicole Renee Ellis, LPCC-S, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

103828 Issued in KY

Practice address

108 Christine Way
Elizabethtown, KY 42701-9681

Phone

(270) 312-2877

NPI assigned

Dec 4, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Baptist Health Medical Group Inc

  • Family Medicine Physician
  • Paducah, KY
  • NPI 1922401611
  Medicare reassignment Care Compare group NPD
• United Healthcare of Hardin, Inc

  • Clinical Social Worker
  • Radcliff, KY
  • NPI 1851500466
  Medicare reassignment NPD
• Baptist Health Medical Group Inc

  • Rural Health Clinic/Center
  • Dawson Springs, KY
  • NPI 1982178216
  NPD
• Pinnacle Inpatient Medical Services, PLLC

  • Family Medicine Physician
  • Radcliff, KY
  • NPI 1386148856
  NPD (past)

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1164580106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 CHRISTINE WAY",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "42701",
            "telephone_number": "270-312-2877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 CHRISTINE WAY",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427019681",
            "telephone_number": "270-312-2877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1072 S Dixie Blvd",
            "address_purpose": "LOCATION",
            "city": "Radcliff",
            "state": "KY",
            "postal_code": "401601103",
            "country_code": "US",
            "telephone_number": "270-351-8166",
            "fax_number": "270-351-8322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "LPCC-S, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2022-07-21",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "103828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30605018",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000498778",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Elliott, MD
• Patricia Elliott, PBS
• Ellis Professional Counseling Services, LLC
• Alice A Ellis, LPCC
• Earl Edward Ellis, M.ED., LPA
• Timothy Ellis, LCSW
• Stephanie Elmore
• Athena V Emerine, SLP
• Encompass Health Rehabilitation Hospital of Lakeview, LLC
• Encouraging Hearts Counseling

• Professional Counselor in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.