Lisa Ellis, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

014613-1 Issued in NY

Practice address

79 Glenridge Rd
Glenville, NY 12302-4528

Phone

(800) 989-6446

NPI assigned

Mar 14, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Physician Assistant

State licenses

Practice roles

Locations

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.

• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Troy, NY
  • NPI 1356396543
  Medicare reassignment
• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Schenectady, NY
  • NPI 1649225897
  NPD
• Beth Israel Medical Center

  • Substance Use Disorder Rehabilitation Hospital Unit
  • New York, NY
  • NPI 1770951204
  NPD (past)
• Bimc Faculty Practice

  • Sports Medicine (Orthopaedic Surgery) Physician
  • New York, NY
  • NPI 1093906828
  NPD (past)

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

{
    "created_epoch": "1300060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1750689865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 GLENRIDGE RD",
            "city": "GLENVILLE",
            "state": "NY",
            "postal_code": "123024528",
            "telephone_number": "800-989-6446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 GLENRIDGE RD",
            "city": "GLENVILLE",
            "state": "NY",
            "postal_code": "123024528",
            "telephone_number": "800-989-6446"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 2nd Ave",
            "address_2": "2nd Floor",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100103101",
            "country_code": "US",
            "telephone_number": "212-726-6822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "LISA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-14",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "014613-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Donnelly
• Amy Donovan, D.C.
• Thomas C Dowling
• Dr Paul Baumgarten
• Ellis Hospital
• Empire Vision Center, Inc
• Don Patton Evans, D.D.S.
• Kellyann Farnum, PT
• Megan L Farwell, M.S. CCC-SLP
• Elizabeth Foggo, FNP

• Medical Physician Assistant in Glenville, NY
• Providers in Glenville, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.