Active NPI
Dustin Smith Ellis
- Case Manager/Care Coordinator
- Brentwood, TN
National Provider Identifier
1306002860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 500 Wilson Pike Cir
Suite 320
Brentwood, TN 37027-5252 - Phone
- (615) 376-0034
- Fax
- (615) 376-3488
- NPI assigned
- Aug 4, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
500 Wilson Pike Cir
Suite 320
Brentwood, TN 37027-5252
Mailing address
500 Wilson Pike Cir
Suite 320
Brentwood, TN 37027-5252
Phone (615) 376-0034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 19, 2024 through Mar 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217808000000",
"number": "1306002860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 WILSON PIKE CIR",
"address_2": "SUITE 320",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370275252",
"telephone_number": "615-376-0034",
"fax_number": "615-376-3488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 WILSON PIKE CIR",
"address_2": "SUITE 320",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370275252",
"telephone_number": "615-376-0034",
"fax_number": "615-376-3488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "DUSTIN",
"middle_name": "SMITH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-04",
"last_updated": "2008-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.