Ellen Lille Ellsworth, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4277 T228 Issued in OH

Practice address

9930 Johnnycake Ridge Rd
Suite 4B
Mentor, OH 44060-6752

Phone

(440) 352-8031

Fax

(440) 352-7671

NPI assigned

Feb 2, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Ellen L. Ellsworth, OD Inc

  • Optometrist
  • Mentor, OH
  • NPI 1568642890
  Medicare reassignment NPD Authorized official
• Clint Paxson O.D. LLC

  • Optometrist
  • Willoughby Hills, OH
  • NPI 1780642439
  NPD (past)

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214956800000",
    "number": "1437297264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9930 JOHNNYCAKE RIDGE RD",
            "address_2": "SUITE 4B",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606752",
            "telephone_number": "440-352-8031",
            "fax_number": "440-352-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9930 JOHNNYCAKE RIDGE RD",
            "address_2": "SUITE 4B",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606752",
            "telephone_number": "440-352-8031",
            "fax_number": "440-352-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "ELLEN",
        "middle_name": "LILLE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2008-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "4277 T228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0841316",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth B Wyatt PHD Inc
• Ellen L. Ellsworth, OD Inc
• Clay Ellenwood, PA-C
• Kristi Ann Ellis, PHARMD
• Jeanine Ellison
• Veronique L Elmore
• Samantha Ely
• Emamayte Limited
• Courtney Marie Emerick
• Empowerme Rehabilitation Illinois, LLC

• Optometrist in Mentor, OH
• Providers in Mentor, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.