NPIMap

Organization Active NPI

Ellis Medical Center, LLC

  • Primary Care Clinic/Center
  • Bloomfield, CT
National Provider Identifier
1346484672
Registry record updated Apr 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
041803 Issued in CT
Legal business name
ELLIS MEDICAL CENTER, LLC
Practice address
701 Cottage Grove Rd
Suite A110
Bloomfield, CT 06002-3080
Phone
(860) 243-1864
NPI assigned
Apr 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2009

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

Authorized official

Name
Dr. Lenworth Ellis, M.D.
Title
Managing Member
Phone
(860) 243-1864

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 041803 CT Primary

Addresses

Primary practice location

701 Cottage Grove Rd
Suite A110
Bloomfield, CT 06002-3080

Mailing address

701 Cottage Grove Rd
Suite A110
Bloomfield, CT 06002-3080
Phone (860) 243-1864

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1346484672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD",
            "address_2": "SUITE A110",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023080",
            "telephone_number": "860-243-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD",
            "address_2": "SUITE A110",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023080",
            "telephone_number": "860-243-1864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-30",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "LENWORTH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "860-243-1864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CT",
            "license": "041803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.