Active NPI
Ellen J. Killebrew, MD
- Cardiovascular Disease Physician
- Richmond, CA
National Provider Identifier
1497928733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- G14853
- Practice address
- 901 Nevin Ave
Richmond, CA 94801-3143 - Phone
- (510) 307-1708
- NPI assigned
- Apr 8, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | G14853 | CA | Primary |
Addresses
Primary practice location
901 Nevin Ave
Richmond, CA 94801-3143
Mailing address
901 Nevin Ave
Richmond, CA 94801-3143
Phone (510) 307-1708
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G148530 | Medicaid | CA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1497928733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 NEVIN AVE",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948013143",
"telephone_number": "510-307-1708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 NEVIN AVE",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948013143",
"telephone_number": "510-307-1708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLEBREW",
"first_name": "ELLEN",
"middle_name": "J.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-08",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "G14853",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G148530",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.