Kelley Anne Ellsworth, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA031761 Issued in DC

Practice address

3301 New Mexico Ave NW Ste 205
Washington, DC 20016-3627

Phone

(202) 243-2500

NPI assigned

Apr 27, 2019

Sex

Female

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 MA, DC2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vineyard Medical Care LLCGroup PAC ID 7416279591, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Martha'S Vineyard Hospital Inc Hospital, Oak Bluffs, MA, CCN 221300

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Vineyard Medical Care LLC

  • Internal Medicine Physician
  • Vineyard Haven, MA
  • NPI 1346649886
  Medicare reassignment Care Compare group
• Medstar Medical Group II LLC

  • General Practice Physician
  • Baltimore, MD
  • NPI 1184046187

  DC

  Medicare reassignment
• Medstar Medical Group II LLC

  dba MMG Emergency Medicine Cfnrg

  • Emergency Medical Services (Emergency Medicine) Physician
  • Washington, DC
  • NPI 1558189712
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Martha'S Vineyard Hospital, Inc.

  • Critical Access Hospital
  • Oak Bluffs, MA
  • NPI 1134206386
  Care Compare affiliation

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

{
    "created_epoch": "1556323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1710541487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3135 38TH ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200163726",
            "telephone_number": "202-744-4983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 NEW MEXICO AVE NW STE 205",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200163627",
            "telephone_number": "202-243-2500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3135 38th St NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200163726",
            "country_code": "US",
            "telephone_number": "202-744-4983",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "364 State Rd",
            "address_purpose": "LOCATION",
            "city": "Vineyard Haven",
            "state": "MA",
            "postal_code": "025685624",
            "country_code": "US",
            "telephone_number": "508-693-4400",
            "fax_number": "508-693-2098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "KELLEY",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-27",
        "last_updated": "2022-06-15",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DC",
            "license": "PA031761",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7445",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lamont Tairi Ellison
• Merri Doretha Ellison
• Rachelle Ellison
• Rashad Ellison
• Eric Ellsworth, MS, MBA
• Peter Joseph Ellsworth, PHD
• Ellyn L Turer PSYD PLLC
• Mona Elmacken, MD
• Omar Elmasry
• Susan Stein Elmendorf, MSW

• Physician Assistant in Washington, DC
• Providers in Washington, DC by specialty
• Physician Assistant in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.
• 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.