NPIMap

Individual provider Active NPI

Ronald K Ellsworth, MD

  • Family Medicine Physician
  • Cascade, ID
National Provider Identifier
1245556141
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-11978 Issued in ID
Practice address
402 Lake Cascade Pkwy
Cascade, ID 83611-7702
Phone
(208) 382-4242
Fax
(208) 382-5081
NPI assigned
Apr 16, 2010
Last updated
Feb 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M-11978 ID Primary

Addresses

Primary practice location

402 Lake Cascade Pkwy
Cascade, ID 83611-7702

Mailing address

PO Box 1330
Cascade, ID 83611-1330
Phone (208) 382-4242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130723000595 ID Practitioner - Family Practice 3971778358 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arizona College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

402 Lake Cascade Pkwy
Cascade, ID 83611-7702
Phone (208) 382-4285

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-11978IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cascade Medical Center Hospital District Family Medicine CurrentSince Aug 15, 2017 Accepting new patients
Shoshone Medical Center CurrentSince Jul 1, 2014 Accepting new patients
Shoshone Medical Center Family Medicine CurrentSince Jul 1, 2014 Accepting new patients
Cascade Medical Center Hospital District CurrentSince Aug 15, 2017 Accepting new patients
Cascade Medical Center Hospital District Family Medicine Past Accepting new patients

Locations

25 Jacobs Gulch Rd
Kellogg, ID 83837
Phone (208) 784-1221

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/9a0a9763-cc6e-4ca0-bdec-c16291c965b9/
  • Direct secure messaging: rellsworth2576873@direct.trinity-health.org
  • Direct secure messaging: rellsworth841415@direct.ochin.org
  • Direct secure messaging: ronald.ellsworth.1@15123.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1271376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1245556141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1330",
            "city": "CASCADE",
            "state": "ID",
            "postal_code": "836111330",
            "telephone_number": "208-382-4242",
            "fax_number": "208-382-5081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 LAKE CASCADE PKWY",
            "city": "CASCADE",
            "state": "ID",
            "postal_code": "836117702",
            "telephone_number": "208-382-4242",
            "fax_number": "208-382-5081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "RONALD",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-16",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-11978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cascade, ID

Sources for this page

Verify at the official NPI Registry.