MS. LISA ANNETTE ELLINGWOOD APRN, PMHNP-BC
NPI 1083255343
Nurse Practitioner - Psychiatric/Mental Health in Champaign, IL

Q: What is Lisa Ellingwood's NPI number?

The NPI number for Lisa Ellingwood is 1083255343. It was assigned to this individual provider in the NPPES registry on October 7, 2019. The provider is also known as Lisa Annette Ellingwood Rn.

Q: What is Lisa Ellingwood's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Lisa Ellingwood was last updated on April 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 07, 2019PECOS EnrolledAccepts Medicare Assignment

1802 S MATTIS AVE, CHAMPAIGN, IL 61821(217) 365-2855(217) 365-2856 Get Directions Write a Review

NPPES record last updated: April 22, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 22, 2024, Jun 2, 2020, Oct 7, 2019 (3 updates tracked since 2019).

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About Ms. Lisa Annette Ellingwood Aprn, Pmhnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. LISA ANNETTE ELLINGWOOD APRN, PMHNP-BC (NPI 1083255343) is an individual psychiatric/mental health provider in Champaign, Illinois, licensed in Illinois (209.020407) and active in the NPI registry since October 2019. She is enrolled in Medicare PECOS, is affiliated with Carle Foundation Hospital, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1083255343

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMS. LISA ANNETTE ELLINGWOODCredential: APRN, PMHNP-BC

Location Address1802 S MATTIS AVEChampaign, IL 61821-5923

Mailing Address1802 S. Mattis AveChampaign, IL 61821 · (217) 365-2855 · Fax (217) 365-2856

Phone(217) 365-2855

Fax(217) 365-2856

Sole ProprietorYes

Medical School CMSOtherGraduated 2019

Enumeration DateOctober 7, 2019

Last NPPES UpdateApril 22, 20243 updates tracked since enumeration

NPPES CertifiedJune 2, 2020

✔ NPI 1083255343 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in IL · 209.020407

Also ListedRegistered NurseTaxonomy 163W00000X · License 041.385774 (IL)

1802 S MATTIS AVE, Champaign, IL 61821

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Other Names 1

Other Name (5)Lisa Annette Ellingwood Rn

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Lisa Annette Ellingwood Aprn, Pmhnp-bc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1355777277

PECOS Enrollment IDI20200212000577

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Carle Foundation Hospital

Acute Care Hospitals · Urbana, IL

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140091

Location611 West Park StreetUrbana, IL 61801 · Champaign County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61821 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RACHAEL D RUBIN PHD

Psychologist