Karen Elizabeth Ellis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12010148A Issued in IN

Practice address

3401 E Raymond St
Indianapolis, IN 46203-4744

Phone

(317) 788-9769

NPI assigned

Oct 20, 2009

Last updated

Dec 28, 2020By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kellis13582@direct.eskenazihealth.edu

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.

• Eskenazi Medical Group Inc

  • Adult Medicine Physician
  • Indianapolis, IN
  • NPI 1730451063
  Medicare reassignment NPD

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

{
    "created_epoch": "1255996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1871829218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 E RAYMOND ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462034744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 E RAYMOND ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462034744",
            "telephone_number": "317-788-9769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KAREN",
        "middle_name": "ELIZABETH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-20",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010148A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200296410",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kellis13582@eskenazihealth.edu",
            "affiliation": "N",
            "address_1": "1650 N College Ave",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gina B Ellis, PHARM.D.
• Harriett Ellis
• Jennifer L Ellis, P.T.
• John Conard Ellis, MD
• Karah Ellis
• Kathleen Annette Ellis
• Kayla Ellis, MD
• Pamela Sue Ellis, RPH
• Ryan Joseph Ellis, MD
• Shaneise Ellis, MD, MBA

• Dentist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; 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.