Active NPI
Robert Frank Ellis, MD
- Gynecology Physician
- Deerfield, IL
National Provider Identifier
1265534697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 01028917A
- Practice address
- 770 Elysian Way
Deerfield, IL 60015-4500 - Phone
- (219) 671-1154
- NPI assigned
- Sep 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 01028917A | IN | Primary |
Addresses
Primary practice location
770 Elysian Way
Deerfield, IL 60015-4500
Mailing address
770 Elysian Way
Deerfield, IL 60015-4500
Phone (219) 671-1154
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151222002548 | IN | Order and Referring Only - Obstetrics/Gynecology | 2860793551 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01028917A | IN | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573084800000",
"number": "1265534697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "770 ELYSIAN WAY",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600154500",
"telephone_number": "219-671-1154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "770 ELYSIAN WAY",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600154500",
"telephone_number": "219-671-1154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "ROBERT",
"middle_name": "FRANK",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-05",
"last_updated": "2019-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "IN",
"license": "01028917A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deerfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.