Jessica Ellsworth, AU.D.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

81183 Issued in TX

Practice address

17625 El Camino Real Ste 155
Houston, TX 77058-3085

Phone

(281) 809-6008

NPI assigned

Jan 21, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Intermountain Ear Nose and Throat Specialists LLCGroup PAC ID 8022901610, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

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.

• Intermountain Ear,Nose, and Throat Specialists LLC

  • Medical Specialty Clinic/Center
  • Salt Lake City, UT
  • NPI 1487764411
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1205426483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17625 EL CAMINO REAL STE 155",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770583085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17625 EL CAMINO REAL STE 155",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770583085",
            "telephone_number": "281-809-6008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "TX",
            "license": "81183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Ellison, DDS
• William Ellison, MD
• Brogan Ellisor, RBT
• Mary Key Ellisor, LPC
• Carolina Coronel Elliston, LCSW
• Misti G. Ellsworth, D.O.
• Rachel Joy Ellsworth, M.D
• Warren Aldrich Ellsworth IV, MD
• Elly Med Devices LLC
• Barbara Ellzey, WHNP-LPA

• Audiologist in Houston, TX
• Providers in Houston, TX by specialty
• Audiologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.