LESLIE R ELLIS (NPI# 1679542765) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679542765 |
| Entity Type | Individual |
| Full Name | LESLIE R ELLIS |
| Credential | M.D. |
| Practice Address |
4123 Dutchmans Ln Suite 301 Louisville KY 40207-4707 |
| Mailing Address |
Po Box 776351 Chicago IL 60677-6351 |
| Practice Telephone | 5028962500 |
| Practice Fax Number | 5028962527 |
| Mailing Telephone | 5025889490 |
| Mailing Fax Number | 5022725116 |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2018-03-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
35733 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200439570 | 05 | |
| KY | ANTHEM- KCNS | 000000744501 | 01 |
| KY | PASSPORT- KCNS | 50035433 | 01 |
| KY | 64067267 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568889418 | Leslie Ellis | Emergency Medicine | 1 Gustave Apt 4h, L Levy Place, New York, NY 10009 | 2014-03-27 |
| 1730346792 | Leslie Elaine Ellis | Psychologist | 207 Crystal Grove Blvd, Lutz, FL 33548-6452 | 2008-05-19 |
| 1790063212 | Leslie Leeann Ellis | Nurse Practitioner | 205 Hospital Dr Ste A, Mc Kenzie, TN 38201-1649 | 2011-08-01 |
| 1790861128 | Leslie R Ellis | Internal Medicine | Medical Center Blvd, Winston-salem, NC 27157 | 2006-10-27 |
| Street Address |
4123 DUTCHMANS LN SUITE 301 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40207-4707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124022496 | Rhonda W. Howard | Nurse Practitioner | 4123 Dutchmans Ln, Suite 515, Louisville, KY 40207-4707 | 2005-06-02 |
| 1518509777 | Blair Kelly Wagner | Nurse Practitioner | 4123 Dutchmans Ln, Louisville, KY 40207-4707 | 2019-10-09 |
| 1750805966 | Patrick Mcrae | Nurse Practitioner | 4123 Dutchmans Ln, Louisville, KY 40207-4707 | 2017-07-29 |
| 1285006049 | Erin M Parker | Nurse Practitioner | 4123 Dutchmans Ln, Suite 101, Louisville, KY 40207-4707 | 2015-10-20 |
| 1831434455 | Eran Rosenberg | Urology | 4123 Dutchmans Ln, Suite 102, Louisville, KY 40207 | 2012-12-07 |
| 1790076487 | Katherine E Caldwell | Pediatrics | 4123 Dutchmans Ln, Suite 301, Louisville, KY 40207-4707 | 2011-04-28 |
| 1851690846 | Angela Marie Cox | Pediatrics | 4123 Dutchmans Ln, Suite 301, Louisville, KY 40207-4707 | 2011-03-16 |
| 1467759035 | Jaclyn Haley Alexander | Nurse Practitioner | 4123 Dutchmans Ln, Ste. 300, Louisville, KY 40207-4707 | 2011-02-17 |
| 1306152939 | Ansel Tsung Jin Tjin-a-tam | Pediatrics | 4123 Dutchmans Ln, Suite 301, Louisville, KY 40207-4707 | 2010-08-19 |
| 1790002517 | Daniel Nathan Ginn | Obstetrics & Gynecology | 4123 Dutchmans Ln, Ste. 300, Louisville, KY 40207-4707 | 2010-05-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780212688 | Alexia Louise Bodamer | Student in an Organized Health Care Education/Training Program | 142 Chenoweth Lane, Lousiville, KY 40207 | 2020-03-28 |
| 1467918664 | Amy Rock LLC | Counselor | 4010 Dupont Cir Ste 307, Louisville, KY 40207 | 2019-02-13 |
| 1649745191 | Louisville Optometric Center, IIi, Psc | Optometrist | 285 Hubbards Lane, Suite 300, Louisville, KY 40207 | 2018-10-11 |
| 1184137440 | Crimson Dove Counseling Services Inc | Community/Behavioral Health | 214 Breckenridge Ln., Suite 203, Louisville, KY 40207 | 2017-11-09 |
| 1285157586 | Dickerson Family Enterprise, LLC | Non-emergency Medical Transport (VAN) | 4350 Brownsboro Rd., Ste. 110, Louisville, KY 40207 | 2017-07-19 |
| 1578085296 | Cardiovascular Medical Specialists LLC | Surgery | 100 Mallard Creek Rd Ste 150, Louisville, KY 40207 | 2017-07-14 |
| 1932636305 | Devon Turley | Prevention Professional | 1017 Dupont Rd, Suite 1, Louisville, KY 40207 | 2017-05-17 |
| 1285095539 | Emily Schwartz Crouch | Marriage & Family Therapist | 4010 Dupont Circle, Suite 582, Louisville, KY 40207 | 2016-03-15 |
| 1306201280 | A A and Associates Approved Alcohol/drug Program | Counselor | 4006 Dutchmans Lane, Louisville, KY 40207 | 2015-12-21 |
| 1629433693 | Jewish Hospital and St. Mary's Healthcare, Inc. | General Acute Care Hospital | 3290 Dutchmans Lane, Louisville, KY 40207 | 2015-12-17 |
| Find all providers in zip 40207 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265996961 | Rebecca Decker | Pediatrics | 571 S Floyd St Ste 342, Louisville, KY 40202-3816 | 2019-01-27 |
| 1265676142 | Hannah Fischer | Pediatrics | 571 South Floyd Strret, Ste 342, Louisville, KY 40202 | 2009-04-23 |
| 1730219395 | Saify Abbasi | Pediatrics | 3170 Running Deer Cir, Louisville, KY 40241-6566 | 2007-03-06 |
| 1972693851 | Neonatal Associates | Pediatrics | 601 S Floyd, Ste 804, Louisville, KY 40202 | 2006-10-13 |
| 1144298316 | Ketan C Mehta | Pediatrics | 4123 Dutchmans Ln Ste 301, Louisville, KY 40207-4721 | 2006-03-14 |
| 1427040443 | Scott D Duncan | Pediatrics | 411 E Chestnut St # 2, Louisville, KY 40202-1713 | 2005-08-16 |
| 1801896592 | Karen W Bibb | Pediatrics | 571 S Floyd St, Suite 342, Louisville, KY 40202-3818 | 2005-07-26 |
| 1114527520 | Sheridan Childrens Healthcare Services of Colorado PC | Pediatrics | 100 Health Park Dr, Louisville, CO 80027-9583 | 2020-10-27 |
| 1659637338 | University of Louisville Physicians, Inc. | Pediatrics | 601 S Floyd St, Suite 804, Louisville, KY 40202-1835 | 2012-04-06 |
| 1215293949 | University of Louisivlle Research Foundation | Pediatrics | 601 S Floyd St, Suite 801, Louisville, KY 40202-1835 | 2012-04-06 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40207 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.