Jessica Danielle Ellis
Individual provider Active NPI Gerontology Nurse Practitioner · Flat Rock, NC
NPI 1245659705 · NPPES record last updated Aug 17, 2022
Key facts
- NPI
- 1245659705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 174165 (NC)
- Practice address
- 571 S Allen Rd
Flat Rock, NC 28731-9447 - Phone
- (828) 692-6178
- NPI assigned
- Apr 14, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hospice of Henderson County Inc
Practice addresses (Care Compare)
571 S Allen Rd
Flat Rock, NC 28731-9447
Phone (828) 692-6178
Hospital & facility affiliations
- Adventhealth Hendersonville
- Pardee Hospital Henderson County
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140725000528 | NC | Practitioner - Nurse Practitioner | 3577789635 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 174165 | NC | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospice of Henderson County Inc | Current |
Accepting new patients | |
| Hospice of Henderson County, Inc. | Current |
Accepting new patients |
Locations
571 S Allen Rd
Flat Rock, NC 28731
Phone (828) 692-9633
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 174165 | NC | |
| Gerontology Nurse Practitioner | 363LG0600X | 174165 | NC | Yes |
Addresses
Primary practice location
571 S Allen Rd
Flat Rock, NC 28731-9447
Mailing address
571 S Allen Rd
Flat Rock, NC 28731-9447
Phone (828) 692-6178
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP2800 | Medicaid | SC | |
| 1245659705 | Medicaid | NC |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jellis@fourseasonscfl.org |
Other providers in Flat Rock, NC
- Brandi Lynn Doyle
- Dr William & Patrick Garrison PLLC
- DRS Dollinger & Haldeman PLLC
- Vanessa Jean Dudley
- Lynda Gail Dunbar
- Elizabeth Deering Elzey
- Emily'S Safehouse LLC
- Melody Ann Englert
- Cara Lynn English
- Everett Courtney Engstrom
All providers in Flat Rock, NC · Gerontology Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.