NPIMap

Individual provider Active NPI

Charles Paul Ellsworth, DO

  • Family Medicine Physician
  • Mount Morris, MI
National Provider Identifier
1780786707
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101015196 Issued in MI
Practice address
7057 N Clio Rd
Mount Morris, MI 48458-8261
Phone
(810) 670-0200
Fax
(810) 670-0196
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101015196 MI Primary

Addresses

Primary practice location

7057 N Clio Rd
Mount Morris, MI 48458-8261

Mailing address

3495 S Center Rd
Burton, MI 48519-1455
Phone (810) 424-2011

Other identifiers 10

IdentifierTypeStateIssuer
1051020OtherMOMCLAREN HEALTH PLAN
178241OtherMNGREAT LAKES HEALTH PLAN/UNITED HEALTHCARE
1780786707OtherMNMOLINA HEALTHCARE OF MICHIGAN
080G3610660OtherMIMICHIGAN BLUE CROSS BLUE SHIELD
1780786707MedicaidMI
381908328OtherMIHCAP
381908328-446OtherMNCARE SOURCE OF MICHIGAN
080G310660OtherMIBLUE CARE NETWORK OF MICHIGAN
0992950OtherMIHEALTH PLUS OF MICHIGAN
19870OtherMIHEALTH PLAN OF MICHIGAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040129000995 MI Practitioner - Family Practice 4981507662 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Medical Group Genesys 96 clinicians
Aspirus Ironwood Hospital and Clinics Inc 165 clinicians

Practice addresses (Care Compare)

10785 S Saginaw St
Suite D
Grand Blanc, MI 48439-7003
Phone (810) 695-6337

7057 N Clio Rd
Suite 2
Mount Morris, MI 48458-8261
Phone (810) 670-0200

N10561 Grandview LN
Ironwood, MI 49938-9622
Phone (906) 932-2525

N10561 Granview LN
Grand View Hospital
Ironwood, MI 49938-9622
Phone (906) 932-2525

N10565 Grand View Lane
Ironwood, MI 49938-9622

N10565 Grandview Lane
Ironwood, MI 49938-9622

N10565 Grandview LN Aspirus Ironwood
Aspirus Palliative Medicine Michi
Ironwood, MI 49938-9622
Phone (715) 843-1067

Hospital & facility affiliations

  • Aspirus Ironwood Hospital Hospital, Ironwood, MI, CCN 231333
  • Ascension Genesys Hospital Hospital, Grand Blanc, MI, CCN 230197

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5101015196MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Medical Group Genesys Family Medicine CurrentSince Aug 21, 2018 Accepting new patients
Henry Ford Medical Group Genesys Family Medicine Current Accepting new patients
Genesys Pho LLC CurrentSince Apr 17, 2018 Accepting new patients
Genesys Practice Partners, Inc CurrentSince Sep 1, 2003 Accepting new patients
Genesys Practice Partners Inc Family Medicine Current Accepting new patients
Henry Ford Medical Group Genesys CurrentSince Aug 21, 2018 Accepting new patients
Genesys Practice Partners Inc Family Medicine CurrentSince Sep 1, 2003 Accepting new patients
Great Lakes Bay Health Centers Past Accepting new patients
Hamilton Community Health Network Inc. Past Accepting new patients
Great Lakes Bay Health Centers Past Accepting new patients

Locations

1460 N Center Rd
Burton, MI 48509
Phone (810) 424-2011

2184 S Ballenger Hwy
Flint, MI 48503
Phone (810) 232-5627

307 E Court St
Flint, MI 48502
Phone (810) 341-7370

3495 S Center Rd
Flint, MI 48519
Phone (810) 424-2025

1 Genesys Pkwy
Grand Blanc, MI 48439
Phone (810) 606-5733

10785 S Saginaw St
Ste D
Grand Blanc, MI 48439
Phone (810) 695-6337

3399 Pollock Rd
Ste A
Grand Blanc, MI 48439
Phone (810) 606-7550

7057 N Clio Rd
Mount Morris, MI 48458
Phone (810) 564-2555

Interoperability endpoints

  • Direct secure messaging: charlesellsworth@pmi.allscriptsdirect.net
  • Direct secure messaging: cellsworth1126190@direct.hfhs.org

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418083200000",
    "number": "1780786707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 S CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485191455",
            "telephone_number": "810-424-2011",
            "fax_number": "810-249-4037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7057 N CLIO RD",
            "city": "MOUNT MORRIS",
            "state": "MI",
            "postal_code": "484588261",
            "telephone_number": "810-670-0200",
            "fax_number": "810-670-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "CHARLES",
        "middle_name": "PAUL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2014-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101015196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1051020",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN/UNITED HEALTHCARE",
            "identifier": "178241",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTHCARE OF MICHIGAN",
            "identifier": "1780786707",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN BLUE CROSS BLUE SHIELD",
            "identifier": "080G3610660",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780786707",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCAP",
            "identifier": "381908328",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE SOURCE OF MICHIGAN",
            "identifier": "381908328-446",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK OF MICHIGAN",
            "identifier": "080G310660",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS OF MICHIGAN",
            "identifier": "0992950",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN OF MICHIGAN",
            "identifier": "19870",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Morris, MI

Sources for this page

Verify at the official NPI Registry.