Active NPI
Ellison Marlar, DO
- Student in an Organized Health Care Education/Training Program
- Hialeah, FL
National Provider Identifier
1972266856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 2001 W 68TH St
Hialeah, FL 33016-1801 - Phone
- (305) 823-5000
- NPI assigned
- Oct 18, 2021
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
2001 W 68TH St
Hialeah, FL 33016-1801
Mailing address
2001 W 68TH St
Hialeah, FL 33016-1801
Other practice location 1
1111 W 17th St
Tulsa, OK 74107-1886
Phone (405) 471-9170
Other practice location 2
14601 Detroit Ave
Lakewood, OH 44107-4205
Phone (216) 237-5500
Other names 1
- Ellison Henley
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230612003139 | OH | Order and Referring Only - Family Practice | 5991162596 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717459200000",
"number": "1972266856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 W 68TH ST",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330161801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 W 68TH ST",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330161801",
"telephone_number": "305-823-5000"
}
],
"practiceLocations": [
{
"address_1": "1111 W 17th St",
"address_purpose": "LOCATION",
"city": "Tulsa",
"state": "OK",
"postal_code": "741071886",
"country_code": "US",
"telephone_number": "405-471-9170",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "14601 Detroit Ave",
"address_purpose": "LOCATION",
"city": "Lakewood",
"state": "OH",
"postal_code": "441074205",
"country_code": "US",
"telephone_number": "216-237-5500",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARLAR",
"first_name": "ELLISON",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-18",
"last_updated": "2024-06-04",
"certification_date": "2024-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ELLISON",
"last_name": "HENLEY",
"credential": "DO",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.