Marybeth Pytlik Ellison, MD

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

033211 Issued in CT

Practice address

Sunflower Developmental Pediatrics
11 Wildwood Medical Center
Essex, CT 06426

Phone

(860) 365-9300

Fax

(860) 365-9300

NPI assigned

May 29, 2008

Last updated

Oct 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Marybeth Pytlik Ellison Former name

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mellison5962@direct.ynhh.org

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.

• Fair Haven Community Health Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • New Haven, CT
  • NPI 1104803444
  Medicare reassignment NPD
• Yale University

  dba Yale Medicine

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236

  Pediatrics

  Medicare reassignment NPD
• Fair Haven Community Health Clinic, Inc

  dba Grand Pharmacy

  • Community/Retail Pharmacy
  • Branford, CT
  • NPI 1760051486
  NPD
• Sunflower Developmental Pediatrics

  • Developmental - Behavioral Pediatrics Physician
  • Essex, CT
  • NPI 1912794264
  NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1609034438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 SURREY DR",
            "city": "DURHAM",
            "state": "CT",
            "postal_code": "064223312",
            "telephone_number": "860-262-2462",
            "fax_number": "860-365-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNFLOWER DEVELOPMENTAL PEDIATRICS",
            "address_2": "11 WILDWOOD MEDICAL CENTER",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "06426",
            "telephone_number": "860-365-9300",
            "fax_number": "860-365-9300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Yale Department of Pediatrics",
            "address_2": "15 York St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065103221",
            "country_code": "US",
            "telephone_number": "203-785-4081",
            "fax_number": "203-737-7635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PYTLIK ELLISON",
        "first_name": "MARYBETH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-29",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "033211",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "CT",
            "license": "033211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYBETH",
            "last_name": "ELLISON",
            "middle_name": "PYTLIK",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Portia Pendleton, LMSW
• Peter S. Dixon, M.D, P.C.
• Ellen H. Pfarr, LCSW
• Kristi Poehlmann, APRN
• Anne Procyk, N.D.
• Theresa M Ramponi, APRN
• Raymond Oakes, MSW, LLC
• Laura Jean Reynolds, M.S.,P.T.
• Keith Richter, LCSW
• Christina Fultz Rickenback, APRN

• Developmental - Behavioral Pediatrics Physician in Essex, CT
• Providers in Essex, CT by specialty
• Developmental - Behavioral Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.