Active NPI
Ellise Troutman
- Prosthetics Case Management
- Albany, GA
National Provider Identifier
1720497902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- License
- CO075513
- Practice address
- 2310 Evergreen Dr
Albany, GA 31721-5225 - Phone
- (229) 376-8641
- NPI assigned
- Aug 12, 2014
- Last updated
- Aug 12, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | CO075513 | GA | Primary |
Addresses
Primary practice location
2310 Evergreen Dr
Albany, GA 31721-5225
Mailing address
2310 Evergreen Dr
Albany, GA 31721-5225
Phone (229) 376-8641
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1744P3200X | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO075513 | GA | MD | Prosthetics Case Management |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407801600000",
"number": "1720497902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2310 EVERGREEN DR",
"city": "ALBANY",
"state": "GA",
"postal_code": "317215225",
"telephone_number": "229-376-8641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2310 EVERGREEN DR",
"city": "ALBANY",
"state": "GA",
"postal_code": "317215225",
"telephone_number": "229-376-8641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TROUTMAN",
"first_name": "ELLISE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-12",
"last_updated": "2014-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "GA",
"license": "CO075513",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1744P3200X",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.