Keith Ellis, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05010042A Issued in IN

Practice address

502 E 1100 N
Chesterton, IN 46304

Phone

(219) 926-5850

Fax

(219) 250-2072

NPI assigned

Jun 8, 2010

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

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovative Physical Therapy LLCGroup PAC ID 0941506406, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Innovative Physical Therapy LLC

  • Physical Therapist
  • Chesterton, IN
  • NPI 1578937447
  Medicare reassignment Care Compare group NPD Authorized official
• Accelerated Rehabilitation Centers LTD

  • Physical Therapist
  • Westmont, IL
  • NPI 1205875713
  NPD (past)

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

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637884800000",
    "number": "1972823367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 E 1100 N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049697",
            "telephone_number": "219-926-5850",
            "fax_number": "219-250-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 E 1100 N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "46304",
            "telephone_number": "219-926-5850",
            "fax_number": "219-250-2072"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "265 Morthland Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "46383",
            "country_code": "US",
            "telephone_number": "219-926-5850 x2",
            "fax_number": "219-250-2072",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "60 W 94th Pl",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "46307",
            "country_code": "US",
            "telephone_number": "219-926-5850 x3",
            "fax_number": "219-250-2072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KEITH",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-08",
        "last_updated": "2021-11-26",
        "certification_date": "2021-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05010042A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Rosalie Efantis, C.O.T.A.
• Danielle Ekovich, PTA
• Elements Therapy and Wellness, LLC
• Elite Family Nurse Practitioners, LLC
• Flora Theresa Ellis, RPT
• Tracy Diane Evans
• Lauren Evenson
• Excellence in Renal Care LLC
• Amanda Facer
• Angela Fain, RBT

• Physical Therapist in Chesterton, IN
• Providers in Chesterton, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.