Samantha Ellis, MS, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1033283 Issued in NY

Practice address

44 Pleasant Ave
Walden, NY 12586-1240

Phone

(845) 597-8128

NPI assigned

May 5, 2014

Last updated

May 5, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

City University of New York School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

LGC Nutrition LLCGroup PAC ID 5496167488, 2 clinicians

Marc D Price DO PLLCGroup PAC ID 8527089267, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• LGC Nutrition LLC

  • Registered Dietitian
  • Delmar, NY
  • NPI 1750983995

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD
• Marc D Price DO PLLC

  dba Family Medicine of Malta

  • Family Medicine Physician
  • Mechancville, NY
  • NPI 1902816473
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399248000000",
    "number": "1285044750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 PLEASANT AVE",
            "city": "WALDEN",
            "state": "NY",
            "postal_code": "125861240",
            "telephone_number": "845-597-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 PLEASANT AVE",
            "city": "WALDEN",
            "state": "NY",
            "postal_code": "125861240",
            "telephone_number": "845-597-8128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SAMANTHA",
        "credential": "MS, RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-05",
        "last_updated": "2014-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "1033283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Dolson, PHARMD, RPH
• Donald Segal
• Brooke Nicolle Duffy, OTR/L
• Edgard Quinones P.C.
• Arianna Camille Edwards
• Chasity Christine Eraso, LPN
• Michelle Espinosa, NURSE PRACTITIONER
• Everlin E Fernandez, RN,BSN
• Joy Figueroa
• Flanagan Chiropractic, P.C.

• Registered Dietitian in Walden, NY
• Providers in Walden, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.