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DR. KEVIN RYAN ELLSWORTH M.D.
NPI 1255607263
Pediatrics - Neonatal-Perinatal Medicine in Gilbert, AZ

Active since March 25, 2012PECOS Enrolled
3420 S MERCY RD STE 205, GILBERT, AZ 85297(602) 933-6345 Get Directions Write a Review

NPPES record last updated: December 9, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 9, 2020, Sep 26, 2019, Apr 12, 2018 (3 updates tracked since 2018).

About Dr. Kevin Ryan Ellsworth M.d. NPPES

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

DR. KEVIN RYAN ELLSWORTH M.D. (NPI 1255607263) is an individual neonatal-perinatal medicine provider in Gilbert, Arizona, licensed in Arizona (56178) and active in the NPI registry since March 2012. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1255607263
Entity TypeIndividualMale
Primary Taxonomy2080N0001X
Provider Legal NameDR. KEVIN RYAN ELLSWORTHCredential: M.D.
Location Address3420 S MERCY RD STE 205Gilbert, AZ 85297-0423
Mailing Address3200 E Camelback Rd Ste 250Phoenix, AZ 85018-2327 · (602) 933-1814
Phone(602) 933-6345
Sole ProprietorNo
Enumeration DateMarch 25, 2012
Last NPPES UpdateDecember 9, 20203 updates tracked since enumeration
NPPES CertifiedDecember 9, 2020
✔ NPI 1255607263 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Neonatal-Perinatal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080N0001X
License✔ Licensed in AZ · 56178
Definition
A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
3420 S MERCY RD STE 205, Gilbert, AZ 85297
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1200 1st St SWRochester, MN 55905-0001 · Phone (507) 284-2511
Location 21111 E McDowell RdPhoenix, AZ 85006-2612 · Phone (480) 466-2287

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kevin Ryan Ellsworth M.d. 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 Kevin Ellsworth reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Phoenix Children's Medical Group
7.5 mi
Multi-Specialty
5131 E SOUTHERN AVE
Mesa, AZ 85206
  • Reassigned Medicare billing, Arizona enrollment
  • Medicare enrollment name: Phoenix Children's Hospital
  • 1,416 clinicians in this Medicare group
NPI 1487814240 (602) 933-0002

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

Other Providers at the Same Location NPPES 4

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

DR. GREGORY CARL MARTIN M.D.
Pediatrics (Neonatal-Perinatal Medicine)
3420 S MERCY RD STE 205
GILBERT, AZ 85297
Maricopa County (602) 933-6345
AMY NORTON DPT
Physical Therapist
3420 S MERCY RD STE 205
GILBERT, AZ 85297
Maricopa County (602) 933-3033
DAVID BENNETT
Orthopaedic Surgery (Pediatric Orthopaedic Surgery)
3420 S MERCY RD STE 205
GILBERT, AZ 85297
Maricopa County (602) 933-3033
MARC ANDREW ELLSWORTH MD
Pediatrics (Neonatal-Perinatal Medicine)
3420 S MERCY RD STE 205
GILBERT, AZ 85297
Maricopa County (602) 933-6345

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 Kevin Ellsworth's NPI number?

The NPI number for Kevin Ellsworth is 1255607263. It was assigned to this individual provider in the NPPES registry on March 25, 2012.

Where is Kevin Ellsworth located?

Kevin Ellsworth practices at 3420 S Mercy Rd Ste 205, Gilbert, AZ 85297. The listed phone number is (602) 933-6345.

What is Kevin Ellsworth's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neonatal-Perinatal Medicine, with taxonomy code 2080N0001X.

Is Kevin Ellsworth enrolled in Medicare?

Yes. Kevin Ellsworth is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kevin Ellsworth's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kevin Ellsworth reassigns Medicare benefits to Phoenix Children's Medical Group (Mesa, AZ). 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 Kevin Ellsworth'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 Kevin Ellsworth was last updated on December 9, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.