Individual provider Active NPI

Katie Rose Ellerbrock, M.D

  • General Acute Care Hospital
  • Denver, CO
National Provider Identifier
1346418225
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
2580 Issued in CO
Practice address
1719 E 19TH Ave
5C East
Denver, CO 80218-1235
Phone
(303) 839-6741
NPI assigned
Feb 13, 2008
Last updated
Feb 13, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 2580 CO Primary

Addresses

Primary practice location

1719 E 19TH Ave
5C East
Denver, CO 80218-1235

Mailing address

336 Grant St Apt 301
Denver, CO 80203-4066
Phone (216) 287-8892

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120718000446 CA Practitioner - Anesthesiology 4688830730 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Santa ClaraGroup PAC ID 1254244973, shared by 46 NPIs, 1,000 clinicians

Practice addresses (Care Compare)

751 S Bascom Ave
San Jose, CA 95128-2604
Phone (408) 885-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
61 of 100Reported as group
Quality
59.41
Promoting interoperability
0
Improvement activities
40
Cost
71.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2580COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Dec 18, 2018 Accepting new patients
County of Santa Clara CurrentSince Jan 17, 2019 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Dec 18, 2018 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Dec 18, 2018 Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

Interoperability endpoints

  • Direct secure messaging: kellerbrock10550@santaclaravalley.direct-ci.net

Organizations & group practices 6

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202860800000",
    "number": "1346418225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 GRANT ST APT 301",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802034066",
            "telephone_number": "216-287-8892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 E 19TH AVE",
            "address_2": "5C EAST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802181235",
            "telephone_number": "303-839-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERBROCK",
        "first_name": "KATIE",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CO",
            "license": "2580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.