Jeremiah Ellingsworth, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

02006805A Issued in IN

Practice address

1002 Wishard Blvd Ste 4016
Indianapolis, IN 46202-4164

Phone

(317) 274-6450

NPI assigned

Apr 11, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

William Carey University College of Osteopathic Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Union Associated Physicians Clinic, LLCGroup PAC ID 3375687437, 230 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Union Associated Physicians Clinic, LLC

  • Family Medicine Physician
  • Terre Haute, IN
  • NPI 1891028379
  Medicare reassignment Care Compare group NPD
• Indy ADHD LLC

  • Psychiatry Physician
  • Carmel, IN
  • NPI 1801573381
  NPD Authorized official
• Union Associated Physicians Clinic LLC

  • Dermatology Physician
  • Terre Haute, IN
  • NPI 1407404940
  NPD

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1992268437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 WISHARD BLVD STE 4016",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462024164",
            "telephone_number": "317-274-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 WISHARD BLVD STE 4016",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462024164",
            "telephone_number": "317-274-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSWORTH",
        "first_name": "JEREMIAH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "T-3765",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "02006805A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Eller, B.S., BCABA
• Joey Joyceanne Eller, MSW
• Anne Ellert Seal, LCSW
• Timothy Craig Ellinger
• Elizabeth Ann Ellingson, RPH
• Dawn Marie Ellington, MSN, FNP-C, LAT, ATC
• Brittany Elliot
• Hayden Elliot
• Madison Elliot
• Kirstin Elliott-Noon, PSYD, HSPP

• Psychiatry Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.
• 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.