NPIMap

Organization Active NPI

Ellis Medical Center, LLC

  • Occupational Medicine Clinic/Center
  • Bloomfield, CT
National Provider Identifier
1740424969
Registry record updated May 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
License
041803 Issued in CT
Legal business name
ELLIS MEDICAL CENTER, LLC
Practice address
701 Cottage Grove Rd
Bloomfield, CT 06002-3080
Phone
(860) 243-1864
NPI assigned
May 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2009

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

Authorized official

Name
Dr. Lenworth Ellis, M.D.NPI 1629094206
Title
Managing Member
Phone
(860) 243-1864

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X 041803 CT Primary

Addresses

Primary practice location

701 Cottage Grove Rd
Bloomfield, CT 06002-3080

Mailing address

701 Cottage Grove Rd
Bloomfield, CT 06002-3080
Phone (860) 243-1864

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1241136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241136000000",
    "number": "1740424969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023080",
            "telephone_number": "860-243-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023080",
            "telephone_number": "860-243-1864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-01",
        "last_updated": "2009-05-01",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "LENWORTH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "860-243-1864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "CT",
            "license": "041803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.