Carl Richard Ellis, ED.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

0810001913 Issued in VA

Practice address

4101 Granby St Ste 301
Norfolk, VA 23504-1117

Phone

(757) 640-1882

Fax

(757) 640-0253

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Rick Ellis Other name

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Spectrum Psychological and Neurotherapy PC

  • Psychologist
  • Virginia Beach, VA
  • NPI 1407221716

  Clinical Child & Adolescent

  Medicare reassignment NPD Authorized official
• Carl R. Ellis

  • Clinical Child & Adolescent Psychologist
  • Virginia Beach, VA
  • NPI 1114002581
  NPD (past) Authorized official
• Center for Excellence

  • Clinical Child & Adolescent Psychologist
  • Norfolk, VA
  • NPI 1033393798
  NPD (past) Authorized official

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213228800000",
    "number": "1821173519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 GRANBY ST",
            "address_2": "SUITE 301",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235041117",
            "telephone_number": "757-640-1882",
            "fax_number": "757-640-0253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 GRANBY ST STE 301",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235041117",
            "telephone_number": "757-640-1882",
            "fax_number": "757-640-0253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CARL",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2008-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "VA",
            "license": "0810001913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "058231",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007700580",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RICK",
            "last_name": "ELLIS",
            "prefix": "DR.",
            "credential": "ED.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Catwana Elliott, LPC
• Cynthia Walker Elliott, NNP
• Leanne Elliott, RN
• Alexander Reed Ellis, M.D., M.SC.
• Belinda Ellis
• Nicole Ellis, DPT
• Rachel Ellis, PA-S
• Rebecca Ellis, LCSW
• Lisa Marie Ellison, MA, LMT
• Tierra Domonique Ellison, LPC

• Clinical Child & Adolescent Psychologist in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Clinical Child & Adolescent Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.