Active NPI
Seth Ellis Sr., RDN
- Registered Dietitian
- Opa Locka, FL
National Provider Identifier
1790103661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 265860468
- Practice address
- 1146 Dunad Ave
Opa Locka, FL 33054-3412 - Phone
- (786) 709-0031
- NPI assigned
- Mar 28, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 265860468 | FL | |
| Nutrition Education Nutritionist | 133NN1002X | 265860468 | FL | |
| Registered Dietitian | 133V00000X | 265860468 | FL | Primary |
| Health Educator | 174H00000X | 2010245 | FL |
Addresses
Primary practice location
1146 Dunad Ave
Opa Locka, FL 33054-3412
Mailing address
1146 Dunad Ave
Opa Locka, FL 33054-3412
Phone (786) 709-0031
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Florida International Univ, College of Medicine, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1146 Dunad Ave
Opa Locka, FL 33054-3412
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 265860468 | FL | MD | Registered Dietitian |
| 2010245 | FL | MD | Health Educator |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395964800000",
"number": "1790103661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1146 DUNAD AVE",
"city": "OPA LOCKA",
"state": "FL",
"postal_code": "330543412",
"telephone_number": "786-709-0031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1146 DUNAD AVE",
"city": "OPA LOCKA",
"state": "FL",
"postal_code": "330543412",
"telephone_number": "786-709-0031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "SETH",
"name_suffix": "Sr.",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-28",
"last_updated": "2014-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "FL",
"license": "265860468",
"primary": false
},
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "FL",
"license": "265860468",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "265860468",
"primary": true
},
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "FL",
"license": "2010245",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Opa Locka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; 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.