Amy L Ellenbogen, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

0101266797 Issued in VA

Practice address

1215 Lee St
Charlottesville, VA 22908-0816

Phone

(434) 924-9400

Fax

(434) 982-1618

NPI assigned

May 7, 2013

Last updated

Jul 30, 2021By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Diagnostic Radiology

Education

University of Virginia School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Health Diagnostics of California a Professional CorporationGroup PAC ID 4284621525, 176 clinicians

Smi Imaging LLCGroup PAC ID 3476696220, 380 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

80.3 of 100Reported as group

Quality

75.71

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aellenbogen10061@direct.healthsystem.virginia.edu

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.

• Health Diagnostics of California a Professional Corporation

  dba Simonmed Imaging

  • Diagnostic Radiology Physician
  • Mountain View, CA
  • NPI 1104321959
  Medicare reassignment Care Compare group NPD
• Smi Imaging, LLC

  dba Simonmed Imaging

  • Diagnostic Radiology Physician
  • Scottsdale, AZ
  • NPI 1972004489

  CA

  Medicare reassignment Care Compare group NPD
• Pronet Imaging Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Los Angeles, CA
  • NPI 1528099488
  Medicare reassignment NPD
• San Fernando Valley Interventional Radiology and Imaging Center

  • Vascular-Interventional Technology Radiologic Technologist
  • Encino, CA
  • NPI 1942350889
  Medicare reassignment NPD
• Health Diagnostics of California a Professional Corporation

  • Diagnostic Radiology Physician
  • Redlands, CA
  • NPI 1164053286
  NPD

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

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1336584101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229069007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 LEE ST",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-924-9400",
            "fax_number": "434-982-1618"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1240 Lee St",
            "address_purpose": "LOCATION",
            "city": "Charlottesville",
            "state": "VA",
            "postal_code": "229080817",
            "country_code": "US",
            "telephone_number": "434-243-6888",
            "fax_number": "434-243-6999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1215 Lee St",
            "address_purpose": "LOCATION",
            "city": "Charlottesville",
            "state": "VA",
            "postal_code": "229080816",
            "country_code": "US",
            "telephone_number": "434-297-5055",
            "fax_number": "434-244-9489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLENBOGEN",
        "first_name": "AMY",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-07",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101266797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aellenbogen10061@direct.healthsystem.virginia.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1215 Lee St",
            "city": "Charlottesville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "229080816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elite Medical Transport Fleet Corp (Elite Fleet)
• Elitecare DME Services LLC
• Elizabeth Mandell MD PLC
• Nabil Mohamed Elkassabany, M.D
• Adam Elkhayat, MD
• Kimberly Elliott
• Matthew P. Elliott, MD
• Megan R Elliott, M.D.
• Melissa Elliott
• Payton Fricke Elliott, M.ED., CCC-SLP

• Diagnostic Radiology Physician in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Diagnostic Radiology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.
• 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.