Kameelah L. Ellis, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

179861 Issued in GA

Practice address

33 Upper Riverdale Rd SW Ste 21
Riverdale, GA 30274-2617

Phone

(404) 314-8868

NPI assigned

Aug 2, 2017

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

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26481/brand/1/csg/1/fhir/r4
• Direct secure messaging: kameelah.ellis.2@29063.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Regional Physicians Management Group, LLC

  • Surgery Physician
  • Riverdale, GA
  • NPI 1043677271
  Medicare reassignment NPD
• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  GA

  Medicare reassignment NPD
• South Atlanta Primary Care PC

  • Legal Medicine
  • Jonesboro, GA
  • NPI 1710183454
  NPD (past)

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501632000000",
    "number": "1306360060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1631",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302531631",
            "telephone_number": "404-314-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 UPPER RIVERDALE RD SW STE 21",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742617",
            "telephone_number": "404-314-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KAMEELAH",
        "middle_name": "L.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-02",
        "last_updated": "2017-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "179861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eighty Health and Wellness LLC
• Nnenna Somtochukwu Sandra Ejiogu
• Amarachi Ekeh-Clarke, MD
• Anthonia Obiageri Ekpenike, M.B.B.S
• Lucretia Anastasia Ellick
• Keva Ellis, LPC
• James Emerson, APRN
• En Vida Adult Day Care Center LLC
• En Vida Home Care LLC
• Isaac Engermann, MD

• Nurse Practitioner in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2017; 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.