Active NPI
Robert M Ellsworth, MD
- Diagnostic Radiology Physician
- Worcester, MA
National Provider Identifier
1972578979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 38051
- Practice address
- 135 Gold Star Blvd
Worcester, MA 01606 - Phone
- (508) 853-2716
- Fax
- (508) 856-9025
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 38051 | MA | Primary |
Addresses
Primary practice location
135 Gold Star Blvd
Worcester, MA 01606
Mailing address
630 Plantation St
Worcester, MA 01605
Phone (508) 853-2716
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1150042 | Other | FIRST HEALTH | |
| 5635531 | Other | AETNA | |
| 784213 | Other | MVP HEALTH CARE | |
| C05097 | Other | BLUE SHIELD INDEMNITY | |
| 26802 | Other | HEALTHY START | |
| C05097 | Other | BLUE SHIELD HMO BLUE | |
| 042472266 | Other | ONE HEALTH PLAN | |
| 9900863 | Other | FALLON COMMUNITY HEALTH P | |
| AA4010 | Other | HARVARD PILGRIM HEALTH CA | |
| 042472266 | Other | HEALTHCARE VALUE MANAGEME | |
| 2034107 | Medicaid | MA | |
| 26802 | Other | CHILDRENS MEDICAL SECURIT | |
| 300090862 | Other | RAILROAD MEDICARE | |
| 4476761 | Other | CIGNA HEALTH PLAN | |
| C05097 | Other | BLUE CARE ELECT | |
| C05097 | Other | MEDICARE B | |
| 042472266 | Other | PRIVATE HEALTHCARE SYSTEM | |
| 2034107 | Other | MEDICAID WELFARE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38051 | MA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reliant Medical Group, 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.
-
- Family Medicine Physician
- Worcester, MA
- NPI 1720017528
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233619200000",
"number": "1972578979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 PLANTATION ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01605",
"telephone_number": "508-853-2716",
"fax_number": "508-856-9025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 GOLD STAR BLVD",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01606",
"telephone_number": "508-853-2716",
"fax_number": "508-856-9025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLSWORTH",
"first_name": "ROBERT",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2009-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MA",
"license": "38051",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "1150042",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5635531",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP HEALTH CARE",
"identifier": "784213",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD INDEMNITY",
"identifier": "C05097",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY START",
"identifier": "26802",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD HMO BLUE",
"identifier": "C05097",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONE HEALTH PLAN",
"identifier": "042472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON COMMUNITY HEALTH P",
"identifier": "9900863",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTH CA",
"identifier": "AA4010",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHCARE VALUE MANAGEME",
"identifier": "042472266",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2034107",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHILDRENS MEDICAL SECURIT",
"identifier": "26802",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "300090862",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTH PLAN",
"identifier": "4476761",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE ELECT",
"identifier": "C05097",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE B",
"identifier": "C05097",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE HEALTHCARE SYSTEM",
"identifier": "042472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID WELFARE",
"identifier": "2034107",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.