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LISA ELLIS PA-C
NPI 1750689865
Physician Assistant - Medical in Glenville, NY

Active since March 14, 2011PECOS Enrolled
79 GLENRIDGE RD, GLENVILLE, NY 12302(800) 989-6446 Get Directions Write a Review

NPPES record last updated: August 19, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lisa Ellis Pa-c NPPES

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

LISA ELLIS PA-C (NPI 1750689865) is an individual medical provider in Glenville, New York, licensed in New York (014613-1) and active in the NPI registry since March 2011. She is enrolled in Medicare PECOS and maintains a secondary practice location in New York.

NPPES Registry Identity

NPI1750689865
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameLISA ELLISCredential: PA-C
Location Address79 GLENRIDGE RDGlenville, NY 12302-4528
Mailing Address79 Glenridge RdGlenville, NY 12302-4528 · (800) 989-6446
Phone(800) 989-6446
Sole ProprietorNo
Enumeration DateMarch 14, 2011
Last NPPES UpdateAugust 19, 2021
NPPES CertifiedAugust 19, 2021
✔ NPI 1750689865 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in NY · 014613-1
79 GLENRIDGE RD, Glenville, NY 12302
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Secondary Practice Location 1

Location 1435 2nd Ave, 2nd FloorNew York, NY 10010-3101 · Phone (212) 726-6822

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lisa Ellis Pa-c 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.

Other Providers at the Same Location NPPES 17

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

DR. CHRISTOPHER J RIZZO M.D.
Internal Medicine (Addiction Medicine)
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 952-8142
KRISTEN RIZZUTO LMSW
Counselor (Addiction (Substance Use Disorder))
79 GLENRIDGE RD, COTTAGE #1
GLENVILLE, NY 12302
Schenectady County (518) 952-8140
THOMAS C DOWLING
Nurse Practitioner (Psychiatric/Mental Health)
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 952-8142
LATCHMI CIPRIANA RN
Registered Nurse
79 GLENRIDGE RD, COTTAGE #1
GLENVILLE, NY 12302
Schenectady County (518) 952-8121
CARLY GALLAGHER LMSW
Social Worker
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 399-6446
CONIFER PARK, INC.
Clinic/Center (Rehabilitation, Substance Use Disorder)
79 GLENRIDGE RD, COTTAGE #1
GLENVILLE, NY 12302
Schenectady County (518) 952-8121
MR. ROBERTO C DIMAMBRO CASAC
Counselor (Addiction (Substance Use Disorder))
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 952-8408
DANESH IRANI
Physician Assistant
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 952-8142

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 Lisa Ellis's NPI number?

The NPI number for Lisa Ellis is 1750689865. It was assigned to this individual provider in the NPPES registry on March 14, 2011.

Where is Lisa Ellis located?

Lisa Ellis practices at 79 Glenridge Rd, Glenville, NY 12302. The listed phone number is (800) 989-6446.

What is Lisa Ellis's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Lisa Ellis enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Lisa Ellis was last updated on August 19, 2021. 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.