Russell John Ellicott, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

POD000558 Issued in GA

Practice address

501 Furys Ferry Rd
Martinez, GA 30907-9059

Phone

(706) 738-3298

Fax

(706) 364-4290

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549411200000",
    "number": "1720022452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 FURY'S FERRY ROAD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "30907",
            "telephone_number": "706-738-3298",
            "fax_number": "706-364-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 FURYS FERRY RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079059",
            "telephone_number": "706-738-3298",
            "fax_number": "706-364-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLICOTT",
        "first_name": "RUSSELL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2019-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "SC",
            "license": "96",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "POD000558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00336124A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cherisse M Edwards, PHARMD
• Gregory C. Edwards, PT, DPT, CEEAA
• Esther Ehuie
• Amira El-Sherbeny, RPH
• Sylvia Marie Elam, FNP
• Kristen Harbeson Elliott, OTRL
• Tanya Ellis-Asbury, LPC
• Rachel Cook Elvis, DMD
• Emily Beall LLC
• Enchanted Hearts Home Care Services LLC.

• Podiatrist in Martinez, GA
• Providers in Martinez, GA by specialty
• Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.