Justin Ross Ellingworth, CAA

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

2025024808 Issued in MO

Practice address

1465 S Grand Blvd
Saint Louis, MO 63104-1003

Phone

(314) 617-2000

NPI assigned

Jun 6, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN, MO2 enrollments

Enrollment records 2

Specialty

Anesthesiology Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts

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.

• SSM Health Care Group

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1306589544

  MO

  Medicare reassignment Care Compare group NPD
• Iu Anesthesiology Associates-Pediatrics, LLC

  • Pediatric Anesthesiology Physician
  • Indianapolis, IN
  • NPI 1083651335

  IN

  Medicare reassignment NPD
• Iu Anesthesiology Associates, LLC

  • Anesthesiology Physician
  • Indianapolis, IN
  • NPI 1285684407

  IN

  Medicare reassignment NPD
• Wishard Anesthesia Group, LLC

  • Anesthesiology Physician
  • Indianapolis, IN
  • NPI 1477505022

  IN

  Medicare reassignment NPD
• SSM Health Care Group

  • Dermatopathology Physician
  • Saint Louis, MO
  • NPI 1932844495
  NPD

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1780243451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N MERIDIAN ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462043908",
            "fax_number": "317-962-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-617-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 Riley Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-944-9981",
            "fax_number": "317-944-0282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLINGWORTH",
        "first_name": "JUSTIN",
        "middle_name": "ROSS",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-06",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "IN",
            "license": "75000041A",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "MO",
            "license": "2025024808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John T Ellena, MD
• Elie C Ellenberg, MD
• Lisa G Elles-Borrson, APRN,BC
• Aubrey Lyn Ellinger
• Angel Angelette Rochelle Ellington
• Elliot L Korn MD Inc
• Rod Lee Elliott-Mullens, DO
• Carli J Elliott, RD, LD
• Christopher Elliott, LCSW
• Crystal Renee Elliott, LPN

• All providers in Saint Louis, MO
• Anesthesiologist Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.