Keith Lawrence Ellis, in Bridgeport, CT - Medicare Nurse Practitioner

Keith Lawrence Ellis, is a medicare enrolled "Nurse Practitioner - Pediatrics" in Bridgeport, Connecticut. His current practice location is 46 Albion St, Bridgeport, Connecticut. You can reach out to his office (for appointments etc.) via phone at (203) 330-6000.

Keith Lawrence Ellis is licensed to practice in Connecticut (license number 5501) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1144654666.

Contact Information

	Keith Lawrence Ellis,
	46 Albion St, Bridgeport, CT 06605-2602
	(203) 330-6000
	(203) 330-6008

Map and Direction

Provider's Profile

Full Name	Keith Lawrence Ellis
Gender	Male
Speciality	Nurse Practitioner - Pediatrics
Location	46 Albion St, Bridgeport, Connecticut
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1144654666
Provider Enumeration Date: 09/03/2013
Last Update Date: 09/12/2022

Medicare PECOS Information:

PECOS PAC ID: 9931482643
Enrollment ID: I20170203000106

Medical Identifiers

Medical identifiers for Keith Lawrence Ellis such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1144654666	NPI	-	NPPES
004236136	Medicaid	CT

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0200X	Nurse Practitioner - Pediatrics	5501 (Connecticut)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Keith Lawrence Ellis allows following entities to bill medicare on his behalf.

Entity Name	Connecticut Children's Specialty Group, Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1669448882 PECOS PAC ID: 6002720117 Enrollment ID: O20031113000468

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Keith Lawrence Ellis is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Keith Lawrence Ellis, 46 Albion St, Bridgeport, CT 06605-2602 Ph: (203) 330-6000	Keith Lawrence Ellis, 46 Albion St, Bridgeport, CT 06605-2602 Ph: (203) 330-6000

Reviews and Comments

Nurse Practitioner Nurses in Bridgeport, CT

Ryan Keenan, PMHNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 267 Grant St, Bridgeport, CT 06610 Phone: 203-384-3000
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Patricia Anne Simpson, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 267 Grant St, Bridgeport, CT 06610 Phone: 203-368-3000
Dr. Samantha Mraz, DNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 46 Albion St, Bridgeport, CT 06605 Phone: 203-332-3584
Esther M Mervil, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 471 Barnum Ave, Bridgeport, CT 06608 Phone: 203-333-6864 Fax: 203-332-0376
Asena Derohannesian, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 425 Thorme St, Bridgeport, CT 06606 Phone: 203-275-4115 Fax: 203-275-0198

Keith Lawrence Ellis, - Medicare Nurse Practitioner in Bridgeport, CT