Active NPI
Donald Ellsworth, M.D.
- Family Medicine Physician
- Katy, TX
National Provider Identifier
1659600161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- L6874
- Practice address
- 20214 Braidwood Dr
Suite 215
Katy, TX 77450-2138 - Phone
- (281) 579-3600
- Fax
- (281) 579-2467
- NPI assigned
- Dec 11, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | L6874 | TX | Primary |
Addresses
Primary practice location
20214 Braidwood Dr
Suite 215
Katy, TX 77450-2138
Mailing address
20214 Braidwood Dr
Suite 215
Katy, TX 77450-2138
Phone (281) 579-3600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2012 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L6874 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260489600000",
"number": "1659600161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20214 BRAIDWOOD DR",
"address_2": "SUITE 215",
"city": "KATY",
"state": "TX",
"postal_code": "774502138",
"telephone_number": "281-579-3600",
"fax_number": "281-579-2467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20214 BRAIDWOOD DR",
"address_2": "SUITE 215",
"city": "KATY",
"state": "TX",
"postal_code": "774502138",
"telephone_number": "281-579-3600",
"fax_number": "281-579-2467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLSWORTH",
"first_name": "DONALD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-12-11",
"last_updated": "2009-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "L6874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Katy, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2009; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.