Kenneth R Ellison (NPI# 1831122803, PAC ID# 7113928805) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1831122803 |
| PAC ID by PECOS | 7113928805 |
| Professional Enrollment ID | I20121114000369 |
| Full Name | Kenneth R Ellison |
| Organization Legal Name | NORTHWEST FLORIDA MULTISPECIALTY PHYSICIANS LLC |
| Address |
870 Mack Bayou Rd Santa Rosa Beach FL 32459-7150 |
| Phone Number | 8508633463 |
| Gender | M |
| Credential | PA |
| Graduation Year | 2002 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 5597801779 |
| Number of Group Practice Members | 21 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 100223 | FORT WALTON BEACH MEDICAL CENTER |
| 100122 | NORTH OKALOOSA MEDICAL CENTER |
| 100054 | TWIN CITIES HOSPITAL |
| 100266 | GULF BREEZE HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 369 N Main St, Crestview, FL 32536-3541 | 8508623194 | NORTHWEST FLORIDA MULTISPECIALTY PHYSICIANS LLC |
| 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 8508621111 | NORTHWEST FLORIDA MULTISPECIALTY PHYSICIANS LLC |
| 965 Mar Walt Dr, Fort Walton Beach, FL 32547-6759 | 8508633463 | NORTHWEST FLORIDA MULTISPECIALTY PHYSICIANS LLC |
| 1032 Mar Walt Dr, Suite 230, Ft. Walton Beach, FL 32547-6663 | 8508633463 | NORTHWEST FLORIDA MULTISPECIALTY PHYSICIANS LLC |
| 870 Mack Bayou Rd, Santa Rosa Beach, FL 32459-7150 | 8508633463 | NORTHWEST FLORIDA MULTISPECIALTY PHYSICIANS LLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PHCDRR_3 | Specialized Registry Reporting | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % |
| Organization Legal Name | NORTHWEST FLORIDA MULTISPECIALTY PHYSICIANS LLC |
| Physicians | 21 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| William F Stiles Iii | Urology | Northwest Florida Multispecialty Physicians LLC | 1032 Mar Walt Dr, Suite 230, Ft. Walton Beach, FL 32547-6663 |
| Noah Ridings Converse | Neurosurgery | Northwest Florida Multispecialty Physicians LLC | 870 Mack Bayou Rd, Santa Rosa Beach, FL 32459-7150 |
| Diana M Decotis-smith | Obstetrics/gynecology | Northwest Florida Multispecialty Physicians LLC | 4400 E Hwy 20, Suite 203, Niceville, FL 32578-7700 |
| Tri Huu Huynh | Gastroenterology | Northwest Florida Multispecialty Physicians LLC | 928 B Mar Walt Dr, Fort Walton Beach, FL 32547-6706 |
| Emmanuel Jean-jacques | Physician Assistant | Northwest Florida Multispecialty Physicians LLC | 1032 Mar Walt Dr, Suite 230, Ft. Walton Beach, FL 32547-6663 |
| Stephanie L Caywood | Obstetrics/gynecology | Northwest Florida Multispecialty Physicians LLC | 1032 Mar Walt Dr, Suite 230, Ft. Walton Beach, FL 32547-6663 |
| Beibei Oelrich | Urology | Northwest Florida Multispecialty Physicians LLC | 1032 Mar Walt Dr, Suite 230, Ft. Walton Beach, FL 32547-6663 |
| Eric L Sandwith | Thoracic Surgery | Northwest Florida Multispecialty Physicians LLC | 1032 Mar Walt Dr, Suite 230, Ft. Walton Beach, FL 32547-6663 |
| John R Larson | Physician Assistant | Northwest Florida Multispecialty Physicians LLC | 1032 Mar Walt Dr, Suite 230, Ft. Walton Beach, FL 32547-6663 |
| Joseph Thomas Early | Physician Assistant | Northwest Florida Multispecialty Physicians LLC | 1032 Mar Walt Dr, Suite 230, Ft. Walton Beach, FL 32547-6663 |
| Street Address |
870 MACK BAYOU RD |
| City | SANTA ROSA BEACH |
| State | FL |
| Zip | 32459-7150 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Noah Ridings Converse | Neurosurgery | Northwest Florida Multispecialty Physicians LLC | 870 Mack Bayou Rd, Santa Rosa Beach, FL 32459-7150 |
| John R Neiner | Otolaryngology | 21st Century Oncology, LLC | 870 Mack Bayou Rd, Suite C, Santa Rosa Beach, FL 32459-7161 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Renee R Mccormack | Nurse Practitioner | 201 N Blue Heron Dr, Santa Rosa Beach, FL 32459-0201 | |
| Christine Smiley | Family Medicine | Doc Smiley's Urgent Care LLC | 43 Cassine Way, Suite 102, Santa Rosa Beach, FL 32459-0456 |
| Justin T Smiley | Family Medicine | Doc Smiley's Urgent Care LLC | 43 Cassine Way, Suite 102, Santa Rosa Beach, FL 32459-0456 |
| James Benjamin Renfroe | Neurology | Child Neurology Center of Northwest Florida Pa | 23 Mack Bayou Loop, Suite 100, Santa Rosa Beach, FL 32459-2606 |
| Erin D Fowler | Nurse Practitioner | Sacred Heart Hospital of Pensacola | 27 Mack Bayou Loop, Suite 1000, Santa Rosa Beach, FL 32459-2613 |
| Rebecca G Block | Nurse Practitioner | Sacred Heart Hospital of Pensacola | 27 Mack Bayou Loop, Suite 1000, Santa Rosa Beach, FL 32459-2613 |
| Emilia M Banse | Nurse Practitioner | Emerald Coast Memory Clinic LLC | 225 Turquoise Bch Dr, Santa Rosa Beach, FL 32459-3063 |
| Wendy M Depury | Clinical Social Worker | Emerald Coast Memory Clinic LLC | 225 Turquoise Bch Dr, Santa Rosa Beach, FL 32459-3063 |
| Farid Chekaoui | Psychiatry | Emerald Coast Memory Clinic LLC | 225 Turquoise Bch Dr, Santa Rosa Beach, FL 32459-3063 |
| Carmen Y Brezna | Clinical Social Worker | Emerald Coast Memory Clinic LLC | 225 Turquoise Bch Dr, Santa Rosa Beach, FL 32459-3063 |
| Find all physicians in zip 32459 | |||
| City | SANTA ROSA BEACH |
| Zip Code | 32459 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | SANTA ROSA BEACH + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Kenneth R Ellison.
| 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.