Jamie Ellingwood, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.004875 Issued in IL

Practice address

1300 W Devon Ave
Chicago, IL 60660-1302

Phone

(773) 751-7850

Fax

(773) 338-4049

NPI assigned

Apr 14, 2009

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

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Tapestry 360 Health

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1407981392
  NPD (past)

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409875200000",
    "number": "1952544488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601302",
            "telephone_number": "773-751-7850",
            "fax_number": "773-338-4049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601302",
            "telephone_number": "773-751-7850",
            "fax_number": "773-338-4049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGWOOD",
        "first_name": "JAMIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-14",
        "last_updated": "2014-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Isaac Ellenbogen, M.D.
• Elles Nurturing Nook LLC
• Don Gregory Elligan, PH.D.
• Stephanie Ellinghaus, OT
• Bridgid Ellingson, PT, DPT
• Wanda Elliott-Pearson, MD
• Ashley Elliott, CRC, LCPC
• Brianna Elliott, PA-C
• Daniel Scott Elliott, MD, PHD
• Elizabeth F Elliott, LCSW

• Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; 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.