Christa Lynne Ellingsworth, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704195469 Issued in MI

Practice address

5724 Shannon LN
Clarkston, MI 48348-5165

Phone

(248) 393-0043

NPI assigned

Nov 14, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 MI

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

Nurse Practitioner

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.

• Matrix Medical Plus

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1376973461

  MI

  Medicare reassignment NPD
• Airport Family Physicians LLC

  • Family Medicine Physician
  • Waterford, MI
  • NPI 1417130303
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770655995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5724 SHANNON LN",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483485165",
            "telephone_number": "248-393-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5724 SHANNON LN",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483485165",
            "telephone_number": "248-393-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSWORTH",
        "first_name": "CHRISTA",
        "middle_name": "LYNNE",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704195469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Anne Eick, LMSW
• Susan Einheuser, MSW,LMSW
• Chirine El Mokdad, MD
• Gino Elian
• Elite Provider Group PC
• Roy F Elturk, D.D.S
• Candice Emeigh, PHARMD
• Emergency Neurosurgical Services, PLLC
• Empowerme Rehabilitation, LLC
• Endodontic Associates of Michigan PLLC

• Family Nurse Practitioner in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.