Gregory Timothy Ellermann, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

860 Issued in KS

Practice address

3515 S 4TH St
Professional Association
Leavenworth, KS 66048

Phone

(913) 651-8415

Fax

(913) 772-8580

NPI assigned

Sep 13, 2006

Last updated

Oct 3, 2008By the provider in NPPES

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

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Frederick J Tirrell PHD Professional Association

  dba Professional Association

  • Psychologist
  • Leavenworth, KS
  • NPI 1013076215
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222992000000",
    "number": "1801991195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 EAST 55TH ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64113",
            "telephone_number": "816-333-3262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 S 4TH ST",
            "address_2": "PROFESSIONAL ASSOCIATION",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "66048",
            "telephone_number": "913-651-8415",
            "fax_number": "913-772-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERMANN",
        "first_name": "GREGORY",
        "middle_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2008-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "860",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "01582",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KANSAS",
            "identifier": "043080",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7030764",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KANSAS GROUP",
            "identifier": "004517",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KANSAS CITY BCBS",
            "identifier": "32816022",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Ann Edwards, LMSW
• Beth L Egbert, LCMFT
• Ronald W Egli
• Vickie L. Eich-Fritze, LSCSW
• David Grant Elcock, MD
• April Tamara Ellis, PA
• Brandy Grace Ellis, PH.D.
• David K Ellison
• Emergency Medical Services Kansas, LLC
• Emergent Care Plus of Overland Park, LLC (NextCare Urgent Care)

• Psychologist in Leavenworth, KS
• Providers in Leavenworth, KS by specialty
• Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.