Anthony Forrest Ellis, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 001108 Issued in GA

Practice address

808 Ward St W
Douglas, GA 31533-3514

Phone

(912) 383-0559

Fax

(912) 383-0614

NPI assigned

Aug 8, 2006

Last updated

Sep 7, 2010By 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

Other identifiers 3

Other names 1

• Andy F Ellis Other name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rehabilitation Services of Coffee, IncGroup PAC ID 8426043753, 2 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rehabilitation Services of Coffee, Inc

  • Physical Therapist
  • Douglas, GA
  • NPI 1255440517
  Medicare reassignment Care Compare group NPD
• Rehabilitation Services of Tifton, Inc.

  • Speech-Language Pathologist
  • Tifton, GA
  • NPI 1710958855

  Physical Therapist

  NPD

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283817600000",
    "number": "1528078300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2150",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317932150",
            "telephone_number": "912-383-0559",
            "fax_number": "912-383-0614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 WARD ST W",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315333514",
            "telephone_number": "912-383-0559",
            "fax_number": "912-383-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ANTHONY",
        "middle_name": "FORREST",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2010-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT 001108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000278429G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000278429D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000278429F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDY",
            "last_name": "ELLIS",
            "middle_name": "F",
            "credential": "PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Eddy Duncan, MD
• Dva Renal Healthcare Inc (Douglas Dialysis)
• Ear, Nose and Throat Clinic of Coffee Co.
• Jennifer Eason
• Elite Medical Clinic, LLC
• Felicia Ellis, NP
• Emergency Physicians of Coffee County, LLC
• Envision Healthcare
• Katelin Ethridge, PHARMD
• Glenn Hamilton Evans Sr., MD

• Physical Therapist in Douglas, GA
• Providers in Douglas, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.