Robert M Ellis (NPI# 1316976855, PAC ID# 2062536931) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1316976855 |
| PAC ID by PECOS | 2062536931 |
| Professional Enrollment ID | I20100830000181 |
| Full Name | Robert M Ellis |
| Organization Legal Name | THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA INC |
| Address |
1190 W Main St Kings Daughters Health Vevay IN 47043-3639 |
| Phone Number | 8124272693 |
| Gender | M |
| Medical School | TUFTS UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1965 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 9739089319 |
| Number of Group Practice Members | 71 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 150069 | KING'S DAUGHTERS' HEALTH |
| Address | Phone | Organization |
|---|---|---|
| 1373 E Sr, Suite 62, Madison, IN 47250-7328 | 8128010196 | THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA INC |
| 1373 E State Rd, 62 Kings Daughters Health, Madison, IN 47250-7328 | 8128010801 | THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA INC |
| 445 Clifty Dr, Madison, IN 47250-1607 | THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA INC | |
| 630 Broadway St, Madison, IN 47250-3310 | 8128010802 | THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA INC |
| 1190 W Main St, Kings Daughters Health, Vevay, IN 47043-3639 | 8124272693 | THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA INC |
| Organization Legal Name | THE BETHANY CIRCLE OF KINGS DAUGHTERS OF MADISON INDIANA INC |
| Physicians | 67 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nathan W Polley | Orthopedic Surgery | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 205 Marwill Dr, Carrollton, KY 41008-1500 |
| Jennifer Chang | Anesthesiology | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 1373 E State Rd, 62 Kings Daughters Health, Madison, IN 47250-7328 |
| Mandy C Wilson | Nurse Practitioner | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 1373 E Sr, Suite 62, Madison, IN 47250-7328 |
| Thomas A Barley | Internal Medicine | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 36 Medical Plz, Hanover, IN 47243-9481 |
| Thomas C Eckert | Internal Medicine | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 206 W Tyson St, Versailles, IN 47042-8036 |
| Susan Florene Maderic | Family Medicine | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 10235 Hwy 421 N, Milton, KY 40045-1541 |
| Mary Victoria Conners | Nurse Practitioner | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 630 Broadway St, Madison, IN 47250-3310 |
| Cassandra A Meyer | Nurse Practitioner | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 445 Clifty Dr, Madison, IN 47250-1607 |
| Paul W Cronen | General Surgery | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 1373 E State Rd, 62 Kings Daughters Health, Madison, IN 47250-7328 |
| Jennifer D Roney | Obstetrics/gynecology | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 1373 E State Rd, 62 Kings Daughters Health, Madison, IN 47250-7328 |
| Street Address |
1190 W MAIN ST KINGS DAUGHTERS HEALTH |
| City | VEVAY |
| State | IN |
| Zip | 47043-3639 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Hannah Lair | Nurse Practitioner | The Bethany Circle of Kings Daughters of Madison Indiana Inc | 1190 W Main St, Kings Daughters Health, Vevay, IN 47043-3639 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Elizabeth Newman | Optometry | Lisle Family Eye Care Inc | 405 Ferry St, Vevay, IN 47043-1105 |
| Michael D Flowers | Clinical Social Worker | Community Mental Health Center Inc. | 205 W Main St, Vevay, IN 47043-1178 |
| Troy D Smith | Chiropractic | 315 Ferry St, Suite A, Vevay, IN 47043-1189 | |
| Katia Vassileva Stefanova | Nurse Practitioner | 1190 W Main Street, Suite 300, Vevay, IN 47043-3639 | |
| Tammy Gray | Physical Therapy | Health Services Corporation of Southeastern Indiana | 1035 W Main St, Suite 1, Vevay, IN 47043-9125 |
| Melissa Mefford | Family Medicine | Health Services Corporation of Southeastern Indiana | 1035 W Main St, Suite 1, Vevay, IN 47043-9125 |
| City | VEVAY |
| Zip Code | 47043 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | VEVAY + FAMILY MEDICINE |
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| 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.