Michael V Ellis, PH.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

008630 Issued in NY

Practice address

1A Pine West PLZ
Albany, NY 12205-5557

Phone

(518) 416-9500

Fax

(518) 862-1668

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Martin Neuropsychology PLLC

  • Clinical Neuropsychologist
  • Clifton Park, NY
  • NPI 1760205645
  NPD (past)
• Pine Bush Mental Health, LLP

  • Clinical Psychologist
  • Albany, NY
  • NPI 1962572362
  NPD (past)
• R&M Neuropsychology, PLLC

  • Clinical Neuropsychologist
  • Clifton Park, NY
  • NPI 1497330740
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461715200000",
    "number": "1699700666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 BERKSHIRE DR W",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120651741",
            "telephone_number": "518-862-1533",
            "fax_number": "518-716-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1A PINE WEST PLZ",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055557",
            "telephone_number": "518-416-9500",
            "fax_number": "518-862-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MICHAEL",
        "middle_name": "V",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2016-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NY",
            "license": "008630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colin Michael Ellis, M.D.
• Courtney Ann Ellis, MS OTR/L
• David A Ellis, M.D.
• Heather Ellis, PT
• Kelsey Ellis, CRNA
• Sherry J Ellis, HAIR SPECIALIST
• Curtis Ellison
• Jamie E Ellwood, OTR/L
• Rebecca Ellwood, PA-C
• Kenna Elmendorf-Burns, PA-C

• Counseling Psychologist in Albany, NY
• Providers in Albany, NY by specialty
• Counseling Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; 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.