Brent A Ellsworth (NPI# 1831412063, PAC ID# 1052560844) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1831412063 |
| PAC ID by PECOS | 1052560844 |
| Professional Enrollment ID | I20121011000660 |
| Full Name | Brent A Ellsworth |
| Organization Legal Name | WILLOW SAGE SERVICES LLC |
| Address |
1023 Yellowstone Ave Suite K Pocatello ID 83201-4478 |
| Phone Number | 2082065276 |
| Gender | M |
| Graduation Year | 2009 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 8527341007 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 131324 | LOST RIVERS MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1023 Yellowstone Ave, Suite K, Pocatello, ID 83201-4478 | 2082065276 | WILLOW SAGE SERVICES LLC |
| Organization Legal Name | WILLOW SAGE SERVICES LLC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Cindy L Adamson | Clinical Social Worker | Willow Sage Services LLC | 211 S Woodruff Ave, Suite A3, Idaho Falls, ID 83401-4865 |
| Vonda E Smith | Clinical Social Worker | Willow Sage Services LLC | 211 S Woodruff Ave, Suite A3, Idaho Falls, ID 83401-4865 |
| Street Address |
1023 YELLOWSTONE AVE SUITE K |
| City | POCATELLO |
| State | ID |
| Zip | 83201-4478 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Timothy A Flicker | Physical Therapy | 2839 Margo Ln, Pocatello, ID 83201-1961 | |
| Michael D Lance | Psychiatry | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Kenneth A Cogen | Nephrology | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Randall J Skeem | Internal Medicine | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Martha Elizabeth Franz | Family Practice | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| John L Shuss | General Surgery | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Ciara C Christensen | Clinical Psychologist | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Robin L Hall | Nurse Practitioner | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Laurence L Martens | Family Practice | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Terry J Buccambuso | Diagnostic Radiology | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Find all physicians in zip 83201 | |||
| City | POCATELLO |
| Zip Code | 83201 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | POCATELLO + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Brent A Ellsworth.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.