Elaine Ellis Center of Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

400312000595 Issued in DC

Legal business name

ELAINE ELLIS CENTER OF HEALTH

Practice address

10001 Rhode Island Ave
College Park, MD 20740-1141

Phone

(301) 441-1605

Fax

(301) 345-1609

NPI assigned

Feb 25, 2017

Organization subpart

No

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

Authorized official

Name

Jacquelyn R Walker

Title

Ceo

Phone

(301) 441-1605

Specialties & licenses 3

Addresses

Other identifiers 2

Tax ID family

Elaine Ellis Center of Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Elaine Ellis Center of Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • College Park, MD
  • NPI 1932710183
  NPD tax ID
• Elaine Ellis Center of Health

  • Dental Clinic/Center
  • Washington, DC
  • NPI 1366243768
  NPD tax ID

Locations

Practitioners 1

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

• Allison Denise Raymond, DDS

  • General Practice Dentistry
  • Washington, DC
  • NPI 1093296550
  NPD (past)

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

{
    "created_epoch": "1487980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1184164014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 RHODE ISLAND AVE",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207401141",
            "telephone_number": "301-441-1605",
            "fax_number": "301-345-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10001 RHODE ISLAND AVE",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207401141",
            "telephone_number": "301-441-1605",
            "fax_number": "301-345-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELAINE ELLIS CENTER OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-25",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-441-1605"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "DC",
            "license": "400312000595",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500072600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "082390200",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clinton Ego
• Bernadette I Egwu
• Godwin Ndive Eko, HHA
• Solomon Ekomteh
• Adedayo Adekemisola Ekundayo, PHD CRNP CCRN
• Elaine Ellis Center of Health, Inc.
• Scott A Ellis, MS, ATC
• Helina Airoboma Esene, NP
• Cecile Eleh Edie Etoke
• Olatunde Etti-Williams

• Federally Qualified Health Center (FQHC) in College Park, MD
• Providers in College Park, MD by specialty
• Federally Qualified Health Center (FQHC) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.