Chris Robert Ellis, PTA

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

160.006451 Issued in IL

Practice address

16849 Mallard LN
Lockport, IL 60441-1309

Phone

(708) 476-0350

NPI assigned

Jan 25, 2016

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453680000000",
    "number": "1942667753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16849 MALLARD LN",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604411309",
            "telephone_number": "708-476-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16849 MALLARD LN",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604411309",
            "telephone_number": "708-476-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CHRIS",
        "middle_name": "ROBERT",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-25",
        "last_updated": "2016-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "160.006451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL PT LICENSE",
            "identifier": "160.006451",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Lockport, IL
• Providers in Lockport, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.