Amber Ellis

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5012261 Issued in NC

Practice address

12701 US 70W
Clayton, NC 27520-2195

Phone

(919) 235-1968

NPI assigned

Jun 11, 2019

Last updated

Dec 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wake Specialty Physicians LLCGroup PAC ID 7416006085, 178 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069
• Wakemed, Cary Hospital Hospital, Cary, NC, CCN 340173

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wake Specialty Physicians, LLC

  • Surgery Physician
  • Raleigh, NC
  • NPI 1942440375

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Wake Specialty Physicians LLC

  dba WakeMed Childrens Pediatric Primary Care - Fuquay-Varina Medical Park

  • Pediatrics Physician
  • Fuquay Varina, NC
  • NPI 1578334892
  NPD
• Wake Specialty Physicians, LLC

  dba WakeMed MyCare 365 Primary Care & Urgent Care

  • Family Medicine Physician
  • Zebulon, NC
  • NPI 1699361618
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wakemed

  dba Wakemed Cary Hospital

  • General Acute Care Hospital
  • Cary, NC
  • NPI 1114993086
  Care Compare affiliation
• Wakemed

  dba WakeMed Mental Health & Well-Being Hospital WakeBrook

  • Psychiatric Hospital Unit
  • Raleigh, NC
  • NPI 1780446302
  Care Compare affiliation
• Wakemed

  dba WakeMed Raleigh Campus

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1972579837
  Care Compare affiliation

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1750940847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "877-498-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12701 US 70W",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275202195",
            "telephone_number": "919-235-1968"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "231 N Judd Pkwy NE",
            "address_purpose": "LOCATION",
            "city": "Fuquay Varina",
            "state": "NC",
            "postal_code": "275262694",
            "country_code": "US",
            "telephone_number": "919-235-6410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6888 Brompton Dr",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338093388",
            "country_code": "US",
            "telephone_number": "704-249-7674",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "AMBER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5012261",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "F06190711",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5012261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750940847",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Clayton, NC
• Providers in Clayton, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; 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.