Joe E Ellis, O.D.
Individual provider Active NPI Optometrist · Benton, KY
NPI 1174597934 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1174597934
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1073DT (KY)
- Practice address
- 109 W 5TH St
Benton, KY 42025-1123 - Phone
- (270) 527-7421
- Fax
- (270) 527-3118
- NPI assigned
- Feb 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Clarkson Optometry Midwest Inc
Practice addresses (Care Compare)
109 W 5TH St
Benton, KY 42025-1123
Phone (270) 527-7421
Merit-based Incentive Payment System (MIPS)
- Final score
- 50.88 of 100
- Quality
- 65.23
- Promoting interoperability
- 0
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 36 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100518000123 | KY | Practitioner - Optometry | 9032256615 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1073DT | KY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clarkson Optometry Midwest Inc | Optometrist | Current |
Accepting new patients |
| Clarkson Optometry Midwest Inc | Optometrist | Current |
Accepting new patients |
| 20-20 Eyecare PSC | Optometrist | Past | Accepting new patients |
Locations
109 W 5th St
Benton, KY 42025
Phone (270) 527-7421
3978 Alexandria Pike
Cold Spring, KY 41076
Phone (859) 441-8500
Interoperability endpoints
- jellis@direct.eyecare-partners.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1073DT | KY | Yes |
| Specialist | 174400000X | 1073DT | KY |
Addresses
Primary practice location
109 W 5TH St
Benton, KY 42025-1123
Mailing address
PO Box 256
Benton, KY 42025-0256
Phone (270) 527-7421
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149794 | Other | KY | HEALTHLINK |
| 77010734 | Medicaid | KY | |
| 000000053519 | Other | KY | BLUE CROSS BLUE SHIELD |
| 4349131 | Other | KY | AETNA |
| T54572 | Other | KY | BLUEGRASS FAMILY HEALTH |
Other providers in Benton, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.