Samantha Ellsworth, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704398827 Issued in MI

Practice address

6821 Medbury St
Detroit, MI 48211-3317

Phone

(313) 922-2222

NPI assigned

Jun 1, 2023

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

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.

• Quality Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Detroit, MI
  • NPI 1558493916
  NPD

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

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1891488185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6821 MEDBURY ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482113317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6821 MEDBURY ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482113317",
            "telephone_number": "313-922-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "SAMANTHA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704398827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonya Veronica Ellis, CCC-A
• Valerie Ellis, CCHT
• Angela Ellison
• Matthew S Ellison, D.O.
• Sedalia Ellison, BSW, CADC
• Joseph Charles Ellul, DNP, NP-C
• Habeba Elmadawy
• Heba Ahmed Elmadhoun, PHARMD
• Amir Ahmed Elmasry, MD
• Jaafar Elmenini, MD

• Registered Nurse in Detroit, MI
• Providers in Detroit, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.