Mary T Ellis, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

4704272662 Issued in MI

Practice address

6920 Indianapolis Blvd
Hammond, IN 46324-2206

Phone

(219) 763-8112

Fax

(219) 764-3251

NPI assigned

Nov 5, 2009

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Interoperability endpoints

• Direct secure messaging: mary.ellis.p1@direct.northshorehealth.nextgenshare.com

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401148800000",
    "number": "1306173786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1430",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463689230",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6920 INDIANAPOLIS BLVD",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "463242206",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARY",
        "middle_name": "T",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-05",
        "last_updated": "2014-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MI",
            "license": "4704272662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Doxas, DDS
• Dr. Thomas V. Tsoutsouris
• Ronald L Drewniak, RPH
• Grace W Duarte, DO
• Sanam El-Quesny, PHARMD
• Emerging Renewal, LLC
• Enhanced Care Home Health
• Enhanced Practice Services
• Lillibet G Escalante, CRNA
• Luz Catalina Escamilla, M.S.W., L.S.W, CAS

• Advanced Practice Midwife in Hammond, IN
• Providers in Hammond, IN by specialty
• Advanced Practice Midwife in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; 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.

Verify at the official NPI Registry.