Ellis Enabosi, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

291470 Issued in NY

Practice address

455 Jersey St
Staten Island, NY 10301-2976

Phone

(187) 524-5611

NPI assigned

Mar 24, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

General Surgery

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peyman Younesi MD PLLCGroup PAC ID 4981860202, 98 clinicians

Bronx Medical Practice PCGroup PAC ID 9739496100, 136 clinicians

Fresh Meadows Physician Practice PLLCGroup PAC ID 0941657811, 33 clinicians

Medical Services of Northeastern Queens PLLCGroup PAC ID 4587013446, 32 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles (12 of 16)

Locations (25 of 32)

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678

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.

• Bronx Medical Practice P.C.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1356726087

  Internal Medicine, NY

  Medicare reassignment Care Compare group NPD
• Fresh Meadows Physician Practice PLLC

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1720775083

  Internal Medicine, NY

  Medicare reassignment Care Compare group NPD
• Medical Services of Northeastern Queens PLLC

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1184311441

  Internal Medicine, NY

  Medicare reassignment Care Compare group NPD
• Peyman Younesi MD PLLC

  • Internal Medicine Physician
  • Fresh Meadows, NY
  • NPI 1891053328

  Internal Medicine, NY

  Medicare reassignment Care Compare group NPD
• Care Physicians of Ny, PLLC

  • Physical Medicine & Rehabilitation Physician
  • Hastings on Hudson, NY
  • NPI 1558982199

  NY

  Medicare reassignment NPD
• Essen Medical Associates, PC

  • Legal Medicine
  • Bronx, NY
  • NPI 1366418709

  NY

  Medicare reassignment NPD
• Essen Medical Urgicare, PLLC

  • Urgent Care Clinic/Center
  • Bronx, NY
  • NPI 1841607298

  NY

  Medicare reassignment NPD
• House Call Medical Services of New York, PLLC

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1851345946

  Internal Medicine, NY

  Medicare reassignment NPD
• Integrated Wound Care New York Medical PLLC

  • General Practice Physician
  • Tappan, NY
  • NPI 1639649643

  General Practice, NY

  Medicare reassignment NPD
• My Medical PC

  • Family Medicine Physician
  • Valley Cottage, NY
  • NPI 1518637891

  Internal Medicine, NY

  Medicare reassignment NPD
• Proclave LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • East Orange, NJ
  • NPI 1073481537
  NPD Authorized official
• Essen Medical Associates, PC

  • Podiatrist
  • Bronx, NY
  • NPI 1720799158
  NPD

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

{
    "created_epoch": "1427155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1669866158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1434 WILLIAMSBRIDGE RD FL 2",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612507",
            "telephone_number": "718-618-0401",
            "fax_number": "347-479-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 JERSEY ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012976",
            "telephone_number": "187-524-5611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "460 N Maple Ave",
            "address_purpose": "LOCATION",
            "city": "East Orange",
            "state": "NJ",
            "postal_code": "070174619",
            "country_code": "US",
            "telephone_number": "973-280-9600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2015 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104534303",
            "country_code": "US",
            "telephone_number": "718-299-7295",
            "fax_number": "718-618-6797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENABOSI",
        "first_name": "ELLIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-24",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "291470",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "291470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Empire Ambulatory Endoscopy Center
• Empire Center for Special Surgery, LLC
• Empire Vision Care LLC
• Empire Vision Center, Inc.
• Empire Vision Center, Inc.
• Encouragement Thru Engagement Mental Health Counseling, PLLC
• Endo Associates of Staten Island, PLLC
• Endo-Metabolic Practice PLLC
• Endo-Metabolic Practice PLLC
• Cassie Marie Enea, LMSW

• All providers in Staten Island, NY
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.
• 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.