Active NPI
Susie Ellis, CPM, LM
- Midwife
- Boise, ID
National Provider Identifier
1942620653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- MID-54
- Practice address
- 9540 W Dorsetshire PL
Boise, ID 83704-2229 - Phone
- (208) 284-0200
- NPI assigned
- Apr 21, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | MID-54 | ID | Primary |
Addresses
Primary practice location
9540 W Dorsetshire PL
Boise, ID 83704-2229
Mailing address
9540 W Dorsetshire PL
Boise, ID 83704-2229
Phone (208) 284-0200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MID-54 | ID | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398038400000",
"number": "1942620653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9540 W DORSETSHIRE PL",
"city": "BOISE",
"state": "ID",
"postal_code": "837042229",
"telephone_number": "208-284-0200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9540 W DORSETSHIRE PL",
"city": "BOISE",
"state": "ID",
"postal_code": "837042229",
"telephone_number": "208-284-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "SUSIE",
"name_prefix": "Ms.",
"credential": "CPM, LM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-04-21",
"last_updated": "2014-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "ID",
"license": "MID-54",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.