Kenneth Mark Ellner, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

032377 Issued in GA

Practice address

1265 Upper Hembree Rd
Suite 100
Roswell, GA 30076-1143

Phone

(770) 750-1133

Fax

(770) 751-7410

NPI assigned

Jul 20, 2005

Last updated

Nov 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Dermatology

Education

Baylor College of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlanta Center for Dermatologic Diseases PCGroup PAC ID 3072569318, 8 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

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.

• Atlanta Center for Dermatologic Diseases PC

  • Dermatology Physician
  • Roswell, GA
  • NPI 1417910431
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1447259577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 UPPER HEMBREE RD",
            "address_2": "SUITE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761143",
            "telephone_number": "770-750-1133",
            "fax_number": "770-751-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 UPPER HEMBREE RD",
            "address_2": "SUITE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761143",
            "telephone_number": "770-750-1133",
            "fax_number": "770-751-7410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLNER",
        "first_name": "KENNETH",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2020-11-02",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "032377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kellner@directaddress.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3400C Old Milton Pkwy # 340",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300054438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Brittany Latrese Ellison, CNM
• Embolden Therapeutic Services
• Embracing Hope Homecare Inc
• Emergency Care USA Georgia P.C.
• Emotional Wellness of Roswell
• En Gedi RX, LLC

• Dermatology Physician in Roswell, GA
• Providers in Roswell, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; 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.

Verify at the official NPI Registry.