Paula Lou Ellsworth, NP
Individual provider Active NPI Family Nurse Practitioner · Ithaca, MI
NPI 1255680211 · NPPES record last updated Sep 6, 2012
Key facts
- NPI
- 1255680211
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704187187 (MI)
- Practice address
- 114 N Main St
Ithaca, MI 48847-1132 - Phone
- (989) 875-4166
- Fax
- (989) 875-5168
- NPI assigned
- Sep 6, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sparrow Carson Hospital
Practice addresses (Care Compare)
114 N Main St
Ithaca, MI 48847-1132
Phone (989) 875-4166
1210 E Ctr St
Sparrow Medical Group OBGYN Carson
Ithaca, MI 48847-1606
Phone (989) 584-3107
Hospital & facility affiliations
- University of Michigan Health-Sparrow Carson
- Mymichigan Medical Center Alma
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- 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 |
|---|---|---|---|---|
| I20121211000343 | MI | Practitioner - Nurse Practitioner | 7719139104 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sparrow Carson Hospital | Current |
Accepting new patients | |
| Sparrow Carson Hospital | Current | Accepting new patients | |
| Sparrow Carson Hospital | Current |
Accepting new patients |
Locations
8175 Reliable Pkwy
Chicago, IL 60686
406 E Elm St
Carson City, MI 48811
Phone (517) 584-3131
1014 E Washington St
Greenville, MI 48838
Phone (616) 754-7145
114 N Main St
Ithaca, MI 48847
Phone (989) 875-4166
Interoperability endpoints
- pellsworth53348@sparrowdirecthie.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704187187 | MI | Yes |
Addresses
Primary practice location
114 N Main St
Ithaca, MI 48847-1132
Mailing address
406 E Elm St
Carson City, MI 48811-9693
Phone (989) 584-3131
Other providers in Ithaca, MI
- Donald G Prouty
- Donald G Prouty
- Nina Sue Draper
- Edward Lewis MD PC
- Kourtney Eichorn
- David J Freestone
- Gary a. Schluckebier, DDS, PLLC
- Cody Giddings
- Gratiot County Commission on Aging
- Gratiot Isabella Resd
All providers in Ithaca, MI · Family Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2012. 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.