Tedette L Ellis, A.P.R.N.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

110440 Issued in NE

Practice address

7205 West Center Road
Suite 200
Omaha, NE 68124-2388

Phone

(402) 397-6600

Fax

(402) 397-8318

NPI assigned

Oct 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Mid-City OB-GYN, P.C.

  • Obstetrics & Gynecology Physician
  • Omaha, NE
  • NPI 1861578817
  NPD (past)

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811073869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7205 WEST CENTER ROAD",
            "address_2": "SUITE 200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242388",
            "telephone_number": "402-397-6600",
            "fax_number": "402-397-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7205 WEST CENTER ROAD",
            "address_2": "SUITE 200",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242388",
            "telephone_number": "402-397-6600",
            "fax_number": "402-397-8318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "TEDETTE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "A.P.R.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NE",
            "license": "110440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47072606813",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Milo Jude Ellis
• Mya Ellis, MS, CTRS
• Natalie Ellis
• Sheila J Ellis, MD
• Tara Ellis, LIMHP
• Timothy Ray Ellis, D.D.S
• Zarriya Ellis
• Joseph Robert Ellison, M.D.
• Larry Johnson Ellison, DDS
• Melissa Anne Ellison, MS

• Obstetrics & Gynecology Physician in Omaha, NE
• Providers in Omaha, NE by specialty
• Obstetrics & Gynecology Physician in Nebraska

• 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.