Active NPI
Coleen Ann Ellis, MD
- Family Medicine Physician
- Palmetto, FL
National Provider Identifier
1366416190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME87898
- Practice address
- 1120 10TH St E
Palmetto, FL 34221-4134 - Phone
- (941) 847-7903
- Fax
- (941) 847-7919
- NPI assigned
- Feb 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME87898 | FL | |
| Family Medicine Physician | 207Q00000X | ME87898 | FL | Primary |
Addresses
Primary practice location
1120 10TH St E
Palmetto, FL 34221-4134
Mailing address
1120 10TH St E
Palmetto, FL 34221-4134
Phone (941) 847-7903
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 271958400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME87898 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optumcare Florida Ci, LLC | Past | Accepting new patients | |
| Hunterdon Family Physicians Inc. | Family Medicine | Past | Accepting new patients |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Primary Care Clinic/Center
- Winter Park, FL
- NPI 1720506603
-
- Family Medicine Physician
- Flemington, NJ
- NPI 1306875273
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629072000000",
"number": "1366416190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1120 10TH ST E",
"city": "PALMETTO",
"state": "FL",
"postal_code": "342214134",
"telephone_number": "941-847-7903",
"fax_number": "941-847-7919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 10TH ST E",
"city": "PALMETTO",
"state": "FL",
"postal_code": "342214134",
"telephone_number": "941-847-7903",
"fax_number": "941-847-7919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "COLEEN",
"middle_name": "ANN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-16",
"last_updated": "2021-08-16",
"certification_date": "2021-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME87898",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME87898",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "271958400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palmetto, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.