Active NPI
Marty Leon Ellis, APRN, FNP-C
- Family Nurse Practitioner
- Holton, KS
National Provider Identifier
1225752033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 81573
- Practice address
- 23020 M Rd
Holton, KS 66436-8641 - Phone
- (785) 362-8677
- NPI assigned
- Sep 27, 2022
- Last updated
- Sep 27, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 81573 | KS | Primary |
Addresses
Primary practice location
23020 M Rd
Holton, KS 66436-8641
Mailing address
23020 M Rd
Holton, KS 66436-8641
Phone (785) 362-8677
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Marty@holtondirectcare.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Nov 4, 2022 through Nov 4, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81573 | KS | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664236800000",
"number": "1225752033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23020 M RD",
"city": "HOLTON",
"state": "KS",
"postal_code": "664368641",
"telephone_number": "785-362-8677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23020 M RD",
"city": "HOLTON",
"state": "KS",
"postal_code": "664368641",
"telephone_number": "785-362-8677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "MARTY",
"middle_name": "LEON",
"credential": "APRN, FNP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-27",
"last_updated": "2022-09-27",
"certification_date": "2022-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "KS",
"license": "81573",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Marty@holtondirectcare.com",
"affiliation": "N",
"endpointDescription": "Holton Direct Care professional email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "23020 M Rd",
"city": "Holton",
"state": "KS",
"country_code": "US",
"postal_code": "664368641",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Holton, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.