Amanda L Ellis, APRN.CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.025521 Issued in OH

Practice address

408 9TH St SW
Canton, OH 44707-4714

Phone

(330) 454-2000

NPI assigned

Dec 6, 2019

Last updated

Jan 19, 2022By 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

Medicare fee-for-service enrollment

Enrolled in OH

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

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifecare Family Health and Dental Center, Inc.Group PAC ID 7315959483, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aultman Hospital Hospital, Canton, OH, CCN 360084
• Mercy Medical Center Hospital, Canton, OH, CCN 360070

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifecare Family Health and Dental Center, Inc

  dba Canton Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Canton, OH
  • NPI 1013964923
  Medicare reassignment Care Compare group NPD
• Lifecare Family Health and Dental Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Massillon, OH
  • NPI 1134959000
  NPD
• Lifecare Family Health and Dental Center, Inc

  dba Canton Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Canton, OH
  • NPI 1851592034
  NPD

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

• Aultman Hospital

  • General Acute Care Hospital
  • Canton, OH
  • NPI 1356366991
  Care Compare affiliation
• Cleveland Clinic Mercy Hospital

  dba Mercy Medical Center

  • General Acute Care Hospital
  • Canton, OH
  • NPI 1366433195
  Care Compare affiliation

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

{
    "created_epoch": "1575590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1902443195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 9TH ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447074714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 9TH ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447074714",
            "telephone_number": "330-454-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 Albemarle Ave",
            "address_purpose": "LOCATION",
            "city": "Cuyahoga Falls",
            "state": "OH",
            "postal_code": "442214814",
            "country_code": "US",
            "telephone_number": "330-414-9945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "AMANDA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "APRN.CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-06",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.025521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0414147",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryn Elliott, LPC
• Jahzmon Seville Elliott
• Jennifer Elliott
• Richard Kirk Elliott, DO
• Ellis Michael Healthcare Services
• Draya K Ellis, CCHW
• Jessica Caillet Ellis, RN, MSN
• Lekesa Angelica Ellis, HHA
• Sherri Ellis, RPH
• Helen Marie Elsass, PC, CRC

• Family Nurse Practitioner in Canton, OH
• Providers in Canton, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.