Nichole Kristine Ellis, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

5101018596 Issued in MI

Practice address

187 S Howell St
Hillsdale, MI 49242-2069

Phone

(517) 437-5385

NPI assigned

Dec 31, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hillsdale Community Health Center

  • Rural Health Clinic/Center
  • Hillsdale, MI
  • NPI 1952951014

  Corporate Director

  CMS ownership

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.

• Hillsdale Community Health Center

  • General Acute Care Hospital
  • Hillsdale, MI
  • NPI 1730115940

  Pediatrics

  Medicare reassignment NPD
• Jon C. Herbener, M.D.,P.C.

  • Specialist
  • Hillsdale, MI
  • NPI 1518262096
  NPD (past)

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

{
    "created_epoch": "1230681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279497600000",
    "number": "1174769830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "187 S HOWELL ST",
            "city": "HILLSDALE",
            "state": "MI",
            "postal_code": "492422069",
            "telephone_number": "517-437-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 S HOWELL ST",
            "city": "HILLSDALE",
            "state": "MI",
            "postal_code": "492422069",
            "telephone_number": "517-437-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "NICHOLE",
        "middle_name": "KRISTINE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-31",
        "last_updated": "2010-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101018596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Nicole Dufore
• Veronica J Dula, M.D.
• Brittany Duncan
• Buffy Lynn Dutro, MSW, LLMSW
• Ashley Reanna-Jeanine Earl, PTA
• Embrace Your Health, LLC
• Emerge Mental Health, LLC
• Hannah Engle, PA-C
• Sarah Elizabeth Engle, ATC, NREMT
• Eugene D. Rohacz, D.P.M., P.C.

• Pediatrics Physician in Hillsdale, MI
• Providers in Hillsdale, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.