Carissa Annette Ellsworth, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PAC-0481 Issued in ND

Practice address

1600 W Antelope Dr
Layton, UT 84041-1142

Phone

(801) 807-7177

NPI assigned

May 11, 2012

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

Medicare fee-for-service enrollment

Enrolled in UT, AZ2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Medical Center LLCGroup PAC ID 7012413164, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Independence Home Health Home health agency, Woods Cross, UT, CCN 467337

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carissa.ellsworth.1@12903.direct.athenahealth.com

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.

• Summit Medical Center LLC

  • Family Medicine Physician
  • Taylorsville, UT
  • NPI 1568250835
  Medicare reassignment Care Compare group NPD
• Arizona Em-I Medical Services PC

  • Physician Assistant
  • Yuma, AZ
  • NPI 1144768862
  Medicare reassignment NPD
• Emergency Physicians Integrated Care, LLC

  • Emergency Medicine Physician
  • Salt Lake City, UT
  • NPI 1578598199
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Independence Home Care, LLC

  • Home Health Agency
  • Woods Cross, UT
  • NPI 1205194222
  Care Compare affiliation

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1831458744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 28TH ST W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588012925",
            "telephone_number": "801-450-7525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W ANTELOPE DR",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411142",
            "telephone_number": "801-807-7177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1138 W 3140 N",
            "address_purpose": "LOCATION",
            "city": "Pleasant View",
            "state": "UT",
            "postal_code": "844142683",
            "country_code": "US",
            "telephone_number": "801-450-7525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "CARISSA",
        "middle_name": "ANNETTE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-11",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ND",
            "license": "PAC-0481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefanie Azevedo Elias, DPT
• Amy Ellefsen
• Bryan Ellertson, MD
• Staci Leann Elliott
• Rowan Ellis
• Patricia Ellsworth, DNP
• Abigail Elmer
• Nikole Embury, RN
• Emdr Solutions Inc
• Emergency Physicians Integrated Care

• Medical Physician Assistant in Layton, UT
• Providers in Layton, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.