Ellsworth Medical Group Llc is a medicare enrolled "General Practice" provider in Queen Creek, Arizona. Their current practice location is
21323 S Ellsworth Loop Rd Ste 101, Queen Creek, Arizona. You can reach out to their office (for appointments etc.) via phone at
(480) 307-8440.
Ellsworth Medical Group Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Ellsworth Medical Group Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1467928804.
Healthcare Provider's Profile
Full Name | Ellsworth Medical Group Llc |
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Type | Facility |
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Speciality | General Practice |
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Location | 21323 S Ellsworth Loop Rd Ste 101, Queen Creek, Arizona |
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Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1467928804
- Provider Enumeration Date: 10/23/2018
- Last Update Date: 01/05/2023
Medicare PECOS Information:
- PECOS PAC ID: 4082959267
- Enrollment ID: O20181215000576
Medical Identifiers
Medical identifiers for Ellsworth Medical Group Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1467928804 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
111N00000X | Chiropractor | (* (Not Available)) | Secondary |
208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Secondary |
208D00000X | General Practice | (* (Not Available)) | Primary |
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Ellsworth Medical Group Llc acts as a billing entity for following providers:
Provider Name | John J Koc |
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Provider Type | Practitioner - Chiropractic |
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Provider Identifiers | NPI Number: 1659429215 PECOS PAC ID: 1951200609 Enrollment ID: I20040102000119 |
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Provider Name | Sonja Gerard |
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Provider Type | Practitioner - Nurse Practitioner |
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Provider Identifiers | NPI Number: 1366719965 PECOS PAC ID: 0941460018 Enrollment ID: I20120327000757 |
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Provider Name | Orlando Hubbell |
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Provider Type | Practitioner - Chiropractic |
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Provider Identifiers | NPI Number: 1225410467 PECOS PAC ID: 5799089785 Enrollment ID: I20160211002426 |
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Provider Name | Lisa Lombard |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
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Provider Identifiers | NPI Number: 1083784987 PECOS PAC ID: 1355376781 Enrollment ID: I20160309001615 |
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Provider Name | Collin S Cragun |
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Provider Type | Practitioner - Chiropractic |
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Provider Identifiers | NPI Number: 1770003816 PECOS PAC ID: 8426328741 Enrollment ID: I20170927002321 |
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Provider Name | Genesis Larkins |
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Provider Type | Practitioner - Chiropractic |
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Provider Identifiers | NPI Number: 1194426080 PECOS PAC ID: 3072988559 Enrollment ID: I20230414001567 |
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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. Ellsworth Medical Group Llc 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 |
Ellsworth Medical Group Llc Po Box 6610, Chandler, AZ 85246-6610 Ph: (480) 926-7800 | Ellsworth Medical Group Llc 21323 S Ellsworth Loop Rd Ste 101, Queen Creek, AZ 85142-9865 Ph: (480) 307-8440 |
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