Individual provider Active NPI

Ellen Ross, PA-C

  • Physician Assistant
  • Berlin, NH
National Provider Identifier
1972505733
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0317P Issued in NH
Practice address
59 Page Hill Rd
Berlin, NH 03570-3531
Phone
(603) 752-2900
Fax
(603) 752-3727
NPI assigned
Aug 11, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0317P NH Primary

Addresses

Primary practice location

59 Page Hill Rd
Berlin, NH 03570-3531

Mailing address

133 Pleasant St
Berlin, NH 03570-2006
Phone (603) 752-2040

Other identifiers 6

IdentifierTypeStateIssuer
5830418OtherAETNA GROUP
30330328MedicaidNH
P00100698OtherRAILROAD MEDICARE
0317POtherNHSTATE LICENSE #
0109410YPNH02OtherNHANTHEM BC/BS
3071702MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20040525000568 NH Practitioner - Physician Assistant 6901887280

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0317PNHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Coos County Family Health Services, Inc. Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1972505733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 PLEASANT ST",
            "city": "BERLIN",
            "state": "NH",
            "postal_code": "035702006",
            "telephone_number": "603-752-2040",
            "fax_number": "603-752-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 PAGE HILL RD",
            "city": "BERLIN",
            "state": "NH",
            "postal_code": "035703531",
            "telephone_number": "603-752-2900",
            "fax_number": "603-752-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "ELLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "0317P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP",
            "identifier": "5830418",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30330328",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00100698",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "0317P",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "0109410YPNH02",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3071702",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, NH

Sources for this page

Verify at the official NPI Registry.