Charles Ellis, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 19143 Issued in CA

Practice address

4164 Brockton Ave
Riverside, CA 92501-3400

Phone

(951) 683-5193

NPI assigned

Oct 16, 2006

Last updated

Oct 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV, MD2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Silver State Health Care Services LLCGroup PAC ID 5698072130, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GJFJBD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Silver State Health Care Services, LLC

  • Primary Care Nurse Practitioner
  • Las Vegas, NV
  • NPI 1114318227

  Clinical

  Medicare reassignment Care Compare group NPD
• Psychiatric Associates Professional, LLC

  • Nurse Practitioner
  • Las Vegas, NV
  • NPI 1881219335
  Medicare reassignment NPD
• Total Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Baltimore, MD
  • NPI 1972597425
  Medicare reassignment NPD
• Phoegenesis, Inc

  • Community Health Clinic/Center
  • Baltimore, MD
  • NPI 1871164517
  NPD Authorized official
• Trailways Inc

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1164977369
  NPD (past) Authorized official
• Trailways, Inc

  • Clinical Social Worker
  • Las Vegas, NV
  • NPI 1982975009
  NPD (past) Authorized official
• Total Health Care Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, MD
  • NPI 1225857378
  NPD
• I Am Me Haven to Health , LLC

  • Clinic/Center
  • Las Vegas, NV
  • NPI 1124815113
  NPD (past)
• I Am Me Patient Advocate Agency LLC

  • Community Health Worker
  • Las Vegas, NV
  • NPI 1164049052

  Mental Health

  NPD (past)
• Mobileonedocs, LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Scottsdale, AZ
  • NPI 1629424379
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1215017009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4164 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013400",
            "telephone_number": "951-683-5193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4164 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013400",
            "telephone_number": "951-683-5193"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2725 S Jones Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891465605",
            "country_code": "US",
            "telephone_number": "725-214-1378",
            "fax_number": "702-384-2239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 Division St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212173121",
            "country_code": "US",
            "telephone_number": "410-383-8300",
            "fax_number": "410-383-3160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2024-10-09",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "5980-C",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "26960",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 19143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982975009",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Dennis Ellenberger, D,D,S
• Alexa Nicole Elliott, D.D.S.
• Jay R Elliott, DDS
• Nisha Elliott, MA
• Anne-Michelle Ellis
• Christiana Desiree Ellis
• Florentina Mihaela Ellis
• Lisa Marie Ellis
• Richard Kevin Ellis, DO
• Brett Jacob Ellison, DO

• Clinical Social Worker in Riverside, CA
• Providers in Riverside, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.