Amy Jene Ellingwood, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

71004165A Issued in IN

Practice address

1630 Lafayette Rd Ste 200
Crawfordsville, IN 47933-1092

Phone

(765) 359-2230

Fax

(765) 359-2236

NPI assigned

Aug 7, 2012

Last updated

Mar 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: aellingwood54414@direct.franciscanalliance.org

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.

• Purdue University

  dba Purdue University Student Health Center

  • Student Health Clinic/Center
  • West Lafayette, IN
  • NPI 1346239696
  NPD (past)

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1235486499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 SIERRA DR STE 400",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461437241",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 LAFAYETTE RD STE 200",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479331092",
            "telephone_number": "765-359-2230",
            "fax_number": "765-359-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGWOOD",
        "first_name": "AMY",
        "middle_name": "JENE",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-07",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "2012011503",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71004165A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201115580",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aellingwood54414@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1630 Lafayette Rd Ste 200",
            "city": "Crawfordsville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479331092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anna Durkee
• Victoria Lynn Eades, R.N.
• Brook Elizabeth Earl
• Anthony Steven Edgecombe, D.C.
• Mark Elizondo, MS, LAT, ATC
• Emergency Care Associates of Indiana LLC
• Stacey Emmert, BCBA
• Priyanka Errabelly, PHARM D
• Desiree Evans, PHARMD
• Tami M Everson, RBT

• Adult Health Nurse Practitioner in Crawfordsville, IN
• Providers in Crawfordsville, IN by specialty
• Adult Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.