Jacqueline Ellis, LCSW-C is a medicare enrolled "Social Worker - Clinical" provider in Adamstown, Maryland. Her current practice location is
5144 Doubs Rd, Adamstown, Maryland. You can reach out to her office (for appointments etc.) via phone at
(240) 397-4356.
Jacqueline Ellis is licensed to practice in Maryland (license number 28071) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1003574229.
Healthcare Provider's Profile
| Full Name | Jacqueline Ellis |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 5144 Doubs Rd, Adamstown, Maryland |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1003574229
- Provider Enumeration Date: 12/05/2021
- Last Update Date: 02/06/2026
Medicare PECOS Information:
- PECOS PAC ID: 1951832278
- Enrollment ID: I20240926004542
Medical Identifiers
Medical identifiers for Jacqueline Ellis such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1003574229 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 101YM0800X | Counselor - Mental Health | 28071 (Maryland) | Secondary |
| 1041C0700X | Social Worker - Clinical | 28071 (Maryland) | Primary |
| 1041C0700X | Social Worker - Clinical | 0904017476 (Virginia) | Secondary |
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. Jacqueline Ellis allows following entities to bill medicare on her behalf.
| Entity Name | Backpack Medical Group Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1851177570 PECOS PAC ID: 6507217742 Enrollment ID: O20240111003427 |
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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. Jacqueline 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 |
Jacqueline Ellis, LCSW-C 5144 Doubs Rd, Adamstown, MD 21710-8919 Ph: (240) 397-4356 | Jacqueline Ellis, LCSW-C 5144 Doubs Rd, Adamstown, MD 21710-8919 Ph: (240) 397-4356 |
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