Ellen Eanes Courson, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Valdosta, GA
NPI 1528080496 · NPPES record last updated Jan 18, 2019
Key facts
- NPI
- 1528080496
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 0343089 (GA)
- Practice address
- 604 E Park Ave
Valdosta, GA 31602-3060 - Phone
- (229) 333-0277
- Fax
- (229) 241-1608
- NPI assigned
- Jul 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101210000250 | GA | Practitioner - Obstetrics/Gynecology | 8426245879 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0343089 | GA | MD | Obstetrics & Gynecology Physician |
Interoperability endpoints
- ecourson6882@sgmc.gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 0343089 | GA | Yes |
Addresses
Primary practice location
604 E Park Ave
Valdosta, GA 31602-3060
Mailing address
PO Box 2130
Valdosta, GA 31604-2130
Phone (229) 333-0277
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 355750 | Other | GA | WELLCARE |
| 000470533A | Medicaid | GA | |
| 062093 | Other | GA | BLUECROSSBLUESHIELD |
Other providers in Valdosta, GA
- Christian Cosson
- Ryan Couillou
- Jackquelyn Countee
- Aaron Scott Courington
- Andrew Jerome Courson
- Seth A Courson
- Clifford D Courtenay
- Bree Sierra Cowart
- Steven Justin Cowart
- Rachel Anne Crane
All providers in Valdosta, GA · Obstetrics & Gynecology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.