Elise Marie Ingram, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

156 William St RM 303
New York, NY 10038-5307

Phone

(888) 803-3370

NPI assigned

Oct 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Elise Marie Van Pelt Former name

Medicare fee-for-service enrollment

Enrolled in NY

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

Physician Assistant

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 and National Provider Directory roles.

• Circle Medical Care of New York PC

  • Family Medicine Physician
  • New York, NY
  • NPI 1780425447
  Medicare reassignment NPD
• Carthage Area Hospital Inc

  • Critical Access Hospital
  • Carthage, NY
  • NPI 1053497388
  Medicare reassignment
• Carthage Area Hospital Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Ogdensburg, NY
  • NPI 1013759166
  NPD
• Carthage Area Hospital, Inc.

  • Critical Access Hospital
  • Carthage, NY
  • NPI 1104234376
  NPD

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731801600000",
    "number": "1336650712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WEST ST",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "136199776",
            "telephone_number": "315-493-1000",
            "fax_number": "315-493-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 WILLIAM ST RM 303",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100385307",
            "telephone_number": "888-803-3370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3130 N Swan Rd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857121227",
            "country_code": "US",
            "telephone_number": "315-941-8588",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3130 N Swan Rd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857121227",
            "country_code": "US",
            "telephone_number": "315-941-8588",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3 Bridge St",
            "address_purpose": "LOCATION",
            "city": "Carthage",
            "state": "NY",
            "postal_code": "136191360",
            "country_code": "US",
            "telephone_number": "315-493-3300",
            "fax_number": "315-493-3306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "ELISE",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-12",
        "last_updated": "2024-11-17",
        "certification_date": "2024-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021853",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISE",
            "last_name": "VAN PELT",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Crystal Ingram, D.O.
• Crystal Ingram
• Deangelo Jamal Ingram, DMD
• Donna A. Ingram, M.D.
• Douglas Howard Ingram, M.D.
• Gail Marie Ingram, NP
• Melanie Ingram
• Stephanie Ann Ingram, FNP
• Rosalie Ingrassia, NP
• Amar M Ingravera, DO

• Medical Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2024; 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.