ELLIS PEDIATRICS, PLLC
NPI 1134844426
Pediatrics in Jacksonville, FL
About Ellis Pediatrics, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ELLIS PEDIATRICS, PLLC (NPI 1134844426) is a healthcare organization registered as a pediatrics in Jacksonville, Florida and active in the NPI registry since October 2022. The organization holds a CLIA Waiver certificate valid through January 12, 2027 and lists Kenyanita Ellis, Owner/pediatrician, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ellis Pediatrics, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Ellis Pediatrics, PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 10D2275003
Ellis Pediatrics, PLLC · Jacksonville, FLFrequently 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 Ellis Pediatrics, PLLC's NPI number?
The NPI number for Ellis Pediatrics, PLLC is 1134844426. It was assigned to this organization in the NPPES registry on October 10, 2022.
Where is Ellis Pediatrics, PLLC located?
Ellis Pediatrics, PLLC is located at 12086 Fort Caroline Rd Ste 401, Jacksonville, FL 32225. The listed phone number is (904) 456-9240.
What is Ellis Pediatrics, PLLC's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Ellis Pediatrics, PLLC enrolled in Medicare?
Yes. Ellis Pediatrics, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Ellis Pediatrics, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Pediatric Medicine) reassigns their Medicare billing to Ellis Pediatrics, PLLC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Ellis Pediatrics, PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D2275003) is associated with this NPI, valid through January 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Ellis Pediatrics, PLLC was last updated on March 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Ellis Pediatrics, Pllc · NPI 1134844426
Pediatrics organization in Jacksonville, Florida. Organization record, active in the CMS NPPES registry since October 10, 2022.
## Identity
- **NPI:** 1134844426 (Entity type: Organization)
- **Enumerated:** October 10, 2022
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **Organization subpart:** No
- **Authorized official:** Kenyanita Ellis, OWNER/PEDIATRICIAN
## Practice location
- **Address:** 12086 FORT CAROLINE RD STE 401, Jacksonville, FL 32225-7640
- **Phone:** (904) 456-9240
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Pediatric Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 1, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1134844426) · Data from the CMS NPPES public registry.