Sue A Ellwood, CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP05864 Issued in OH

Practice address

1740 Cleveland Rd
Wooster, OH 44691-2204

Phone

(330) 287-4850

Fax

(330) 264-9804

NPI assigned

Apr 21, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

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.

• Wooster Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Wooster, OH
  • NPI 1033135009
  Medicare reassignment

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267574400000",
    "number": "1720044621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 CLEVELAND RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912204",
            "telephone_number": "330-287-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 CLEVELAND RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912204",
            "telephone_number": "330-287-4850",
            "fax_number": "330-264-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLWOOD",
        "first_name": "SUE",
        "middle_name": "A",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2010-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "RN168210",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "NP05864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2652713",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Elder
• Mark D Elderbrock, M.D.
• Elite DSS Incorporated
• Kayla Marie Elliott
• Lisa Venee Ellis
• Paige Alexandria Emick, QMHS
• Rebecca Engel, COTA/L
• Gary James Engelhardt, SOCIAL WORKER
• Emily Anne Engman, LSW
• Eric T. Richman DPM Inc

• Nurse Practitioner in Wooster, OH
• Providers in Wooster, OH by specialty
• Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.