Ellen Davis

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9112245 Issued in FL

Practice address

130 Pablo St
Lakeland, FL 33803-3818

Phone

(863) 284-5906

Fax

(863) 284-5149

NPI assigned

Jun 11, 2019

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 FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeland Regional Health Systems IncGroup PAC ID 8325952914, 513 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Regional Medical Center Hospital, Lakeland, FL, CCN 100157

Merit-based Incentive Payment System (MIPS)

Final score

86.12 of 100Reported as group

Quality

64.08

Promoting interoperability

98

Improvement activities

40

Cost

76.83

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1497748743
  Medicare reassignment Care Compare group
• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1265585806
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lakeland Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Lakeland, FL
  • NPI 1144228446
  Care Compare affiliation

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1194384362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 LAKELAND HILLS BLVD",
            "address_2": "MANAGED CARE DEPT",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338054543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PABLO ST",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338033818",
            "telephone_number": "863-284-5906",
            "fax_number": "863-284-5149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "ELLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9112245",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Altovise L Davis
• Amanda Lueshen Davis, MD
• Bradley Carl Davis, M.D.
• Carolin Davis, BCBA
• Donald M Davis, M.D.
• Heidi Davis
• Jermaine Davis
• John William Davis, CRNA
• Jordan T Davis, RBT
• Maleaha Faith Davis, MSW

• Surgical Physician Assistant in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; 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.