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MS. BEVERLY DAWN ELLIS APRN
NPI 1124488903
Nurse Practitioner - Family in Jackson, KY

Active since March 07, 2016PECOS Enrolled
1484 LAKESIDE DRIVE, JACKSON, KY 41339(606) 666-9950(606) 666-9136 Get Directions Write a Review

NPPES record last updated: May 4, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 4, 2022, Aug 16, 2021, Mar 12, 2020 (3 updates tracked since 2020).

About Ms. Beverly Dawn Ellis Aprn NPPES

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

MS. BEVERLY DAWN ELLIS APRN (NPI 1124488903) is an individual family provider in Jackson, Kentucky, licensed in Kentucky (3010157) and active in the NPI registry since March 2016. She is enrolled in Medicare PECOS and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1124488903
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMS. BEVERLY DAWN ELLISCredential: APRN
Location Address1484 LAKESIDE DRIVEJackson, KY 41339-6555
Mailing AddressPo Box 690Beattyville, KY 41311-0690 · (606) 464-0151 · Fax (606) 464-0152
Phone(606) 666-9950
Fax(606) 666-9136
Sole ProprietorNo
Enumeration DateMarch 7, 2016
Last NPPES UpdateMay 4, 20223 updates tracked since enumeration
NPPES CertifiedMay 4, 2022
✔ NPI 1124488903 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in KY · 3010157
1484 LAKESIDE DRIVE, Jackson, KY 41339
Open in Google Maps ↗

Secondary Practice Locations 3

Location 1308 N KY 7Sandy Hook, KY 41171-7134 · Phone (606) 738-9785 · Fax (859) 317-2148
Location 2202 Plummer StCampton, KY 41301-9381 · Phone (606) 668-7385 · Fax (606) 668-7009
Location 31219 W Main StWest Liberty, KY 41472-2161 · Phone (606) 743-4808 · Fax (606) 743-4716

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Beverly Dawn Ellis Aprn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Beverly Ellis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Juniper Health Inc
Same address
Federally Qualified Health Center (FQHC)
1484 LAKESIDE DRIVE
Jackson, KY 41339
  • Reassigned Medicare billing, Kentucky enrollment
  • 22 clinicians in this Medicare group
NPI 1467417691 (606) 666-9950

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 41339 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
$82.24 typical visit price
range $52.76 – $162.27
Typical copayment $20.56 (range $13.19 – $40.56)
Most-billed visit code 99203
Established Patient
$93.94 typical visit price
range $16.53 – $131.99
Typical copayment $23.48 (range $4.13 – $32.99)
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.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
4 suppliers13 claims31 services$6.34 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
1 supplier12 claims12 services$200.12 avg. paid by Medicare
Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513
DME-Other DME · category DE000N
2 suppliers14 claims14 services$17.25 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 9

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

REBECCA K SMITH LCSW
Social Worker (Clinical)
1484 LAKESIDE DRIVE
JACKSON, KY 41339
Breathitt County (606) 666-9950
DR. DERRICK JACK HAMILTON D.O.
Internal Medicine
1484 LAKESIDE DRIVE
JACKSON, KY 41339
Breathitt County (606) 666-9950
MS. BRIDGET CHRISTINA TURNER LCSW
Social Worker (Clinical)
1484 LAKESIDE DRIVE
JACKSON, KY 41339
Breathitt County (606) 666-9950
DR. ROGER CARL WORTHINGTON D.M.D.
Dentist (General Practice)
1484 LAKESIDE DRIVE, DENTAL SUITE
JACKSON, KY 41339
Breathitt County (606) 666-9950
JUNIPER HEALTH INC
Clinic/Center (Federally Qualified Health Center (FQHC))
1484 LAKESIDE DRIVE
JACKSON, KY 41339
Breathitt County (606) 666-9950
DR. KIMERLI PLUMB-MOORE M.D.
Pediatrics
1484 LAKESIDE DRIVE
JACKSON, KY 41339
Breathitt County (606) 666-9950
ALLISON MICHELLE MANNING APRN, NP-C
Nurse Practitioner (Family)
1484 LAKESIDE DRIVE
JACKSON, KY 41339
Breathitt County (606) 666-9950
DR. BRITTANY MOORE FUGATE D.O.
Internal Medicine
1484 LAKESIDE DRIVE
JACKSON, KY 41339
Breathitt County (606) 666-9950

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Beverly Ellis's NPI number?

The NPI number for Beverly Ellis is 1124488903. It was assigned to this individual provider in the NPPES registry on March 7, 2016.

Where is Beverly Ellis located?

Beverly Ellis practices at 1484 Lakeside Drive, Jackson, KY 41339. The listed phone number is (606) 666-9950.

What is Beverly Ellis's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Beverly Ellis enrolled in Medicare?

Yes. Beverly Ellis is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Beverly Ellis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Beverly Ellis reassigns Medicare benefits to Juniper Health Inc (Jackson, KY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Beverly Ellis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Beverly Ellis was last updated on May 4, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.