Michelle C Ellison, P. T.

Key facts

NPI

1700968864

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

MS PT0747 (MS)

Practice address

276 Nissan Pkwy
Suite 400, BLDG F
Canton, MS 39046-7006

Phone

(601) 859-3776

Fax

(601) 859-3778

NPI assigned

Oct 19, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 10

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.

• 5 Star Performance Center, LLC Physical Therapy Clinic/Center · Flowood, MS · NPI 1689150054
  Medicare reassignment Care Compare group NPD MS · PHYSICAL THERAPIST
• Dpti Elite Physical Therapy LLC Physical Therapist · Saltillo, MS · NPI 1386010718
  Medicare reassignment NPD MS · PHYSICAL THERAPIST
• Drayer Physical Therapy Mississippi LLC Physical Therapist · Louisville, MS · NPI 1952732448
  Medicare reassignment NPD MS · PHYSICAL THERAPIST
• Ridgeland Sports Medicine & Rehab, Inc Physical Therapy Clinic/Center · Ridgeland, MS · NPI 1871689851
  NPD (past) Authorized official
• Dpti Elite Physical Therapy LLC Physical Therapist · Baldwyn, MS · NPI 1013383496
  NPD PHYSICAL THERAPIST
• Medicomp, Inc Physical Therapist · Magee, MS · NPI 1548305360
  NPD PHYSICAL THERAPIST
• Drayer Physical Therapy Institute LLC Physical Therapist · Columbus, MS · NPI 1073859807
  NPD (past) PHYSICAL THERAPIST
• Drayer Physical Therapy Mississippi LLC Physical Therapist · Crystal Springs, MS · NPI 1801333521
  NPD (past) PHYSICAL THERAPIST
• Medicomp, Inc Physical Therapist · Jackson, MS · NPI 1144338070
  NPD (past) PHYSICAL THERAPIST
• Medicomp, Inc Physical Therapist · Byram, MS · NPI 1346332574
  NPD (past) PHYSICAL THERAPIST

Medicare Care Compare profile

Specialty

Physical Therapist in Private Practice

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

5 Star Performance Center, LLC (3 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MS

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Mrs. Michelle C Lee Professional name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 28, 2016.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1700968864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 HIGHWAY 45 N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397051320",
            "telephone_number": "662-327-6705",
            "fax_number": "662-327-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 NISSAN PKWY",
            "address_2": "SUITE 400, BLDG F",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390467006",
            "telephone_number": "601-859-3776",
            "fax_number": "601-859-3778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "MICHELLE",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "P. T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "MS PT0747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5965404",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "LEE",
            "middle_name": "C",
            "prefix": "MRS.",
            "credential": "P.T.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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All providers in Canton, MS · Physical Therapist in Mississippi