Brent Angel Ellsworth, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-844 Issued in ID

Practice address

2001 S Woodruff Ave Ste 9
Idaho Falls, ID 83404-6371

Phone

(208) 419-3002

Fax

(208) 656-5652

NPI assigned

Mar 2, 2010

Last updated

Nov 2, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ascend LLCGroup PAC ID 5496179574, 8 clinicians

Willow Sage Services LLCGroup PAC ID 8527341007, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Ascend LLC

  dba Ascend Mental Health Center

  • Psychiatry Physician
  • Idaho Falls, ID
  • NPI 1811514870
  Medicare reassignment Care Compare group
• Willow Sage Services LLC

  • Counselor
  • Idaho Falls, ID
  • NPI 1538611652
  Medicare reassignment Care Compare group
• Alliance Home Health of Idaho, LLC

  dba Alliance Hospice

  • Community Based Hospice Care Agency
  • Twin Falls, ID
  • NPI 1467772897
  NPD (past)
• Healthy Place Counseling, Inc.

  • Mental Health Counselor
  • Idaho Falls, ID
  • NPI 1497888713
  NPD (past)
• Seasons of Hope, LLC

  • Community/Behavioral Health Agency
  • Chubbuck, ID
  • NPI 1316251895
  NPD (past)

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1831412063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 9",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046371",
            "telephone_number": "208-419-3002",
            "fax_number": "208-656-5652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 9",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046371",
            "telephone_number": "208-419-3002",
            "fax_number": "208-656-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "BRENT",
        "middle_name": "ANGEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-02",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellis Physical Therapy P a
• Alisa Ellis, LCPC
• Jay T Ellis, PT, DPT, CSCS
• Josie Ellis
• Shelby Lyn Ellis
• Gary Earl Ellwein, MD
• Louis Davis Ellwood
• Michele Marie Elsbree, LMSW
• Marie L Elser, LMSW
• Emergency Orthopedic Services of Idaho PLLC

• Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; 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.
• 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.

Verify at the official NPI Registry.