Glenn Thomas Ellis, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

105 Issued in MS

Practice address

815 2ND Ave No
Columbus, MS 39701

Phone

(662) 327-7388

Fax

(662) 329-1177

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Clinical Psychologist

Education

Other, 1970

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Right Track Medical Group, IncGroup PAC ID 8729403415, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Right Track Medical Group, Inc

  • Psychiatry Physician
  • Olive Branch, MS
  • NPI 1972080257
  Medicare reassignment Care Compare group
• State of Mind Psychiatry, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Starkville, MS
  • NPI 1821812389
  Medicare reassignment NPD
• Precise Clinical Neuroscience Specialists

  • Psychiatry Physician
  • Flowood, MS
  • NPI 1770717449
  Medicare reassignment NPD (past)
• Region Seven Mental Health Intellectual Disabilities Comm

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Point, MS
  • NPI 1700894730
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184712820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 2ND AVE NORTH",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "39701",
            "telephone_number": "662-327-7388",
            "fax_number": "662-329-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 2ND AVE NO",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "39701",
            "telephone_number": "662-327-7388",
            "fax_number": "662-329-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "GLENN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MS",
            "license": "105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115223",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julissa K Edwards
• Kenny B Edwards, MD
• Elite Caring Hands LLC
• Erica Chancey Elkin, FNP
• Pamela Elliott
• Shannon Ellis
• George Pearson Elsberry, DDS
• Abdelrahman Mohamed Ahmed Elshakankiry, MD
• Encore Rehabilitation Inc
• Diana Kim Ennis, NP

• Psychologist in Columbus, MS
• Providers in Columbus, MS by specialty
• Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.