ELIE C ELLENBERG MD
NPI 1942839071
Student in an Organized Health Care Education/Training Program in Saint Louis, MO

Q: What is Elie Ellenberg's NPI number?

The NPI number for Elie Ellenberg is 1942839071. It was assigned to this individual provider in the NPPES registry on April 1, 2020.

Q: What is Elie Ellenberg's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Elie Ellenberg was last updated on March 24, 2021. 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.

Active since April 01, 2020PECOS Enrolled

1201 S GRAND BLVD, SAINT LOUIS, MO 63104(314) 257-8000 Get Directions Write a Review

NPPES record last updated: March 24, 2021. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Mar 24, 2021, Apr 1, 2020 (2 updates tracked since 2020).

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About Elie C Ellenberg Md NPPES

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

ELIE C ELLENBERG MD (NPI 1942839071) is an individual student in an organized health care education/training program in Saint Louis, Missouri and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS, maintains a secondary practice location in Ann Arbor, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1942839071

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameELIE C ELLENBERGCredential: MD

Location Address1201 S GRAND BLVDSaint Louis, MO 63104-1016

Mailing Address934 W Huron StAnn Arbor, MI 48103-4216 · (248) 514-1344

Phone(314) 257-8000

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateApril 1, 2020

Last NPPES UpdateMarch 24, 20212 updates tracked since enumeration

NPPES CertifiedMarch 24, 2021

✔ NPI 1942839071 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1201 S GRAND BLVD, Saint Louis, MO 63104

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Secondary Practice Location 1

Location 11500 E Medical Center DrAnn Arbor, MI 48109-5000 · Phone (734) 936-4000

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Elie C Ellenberg Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7911308002

PECOS Enrollment IDI20260709004608

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 20

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

DOUG LONGO APRN

Nurse Practitioner (Acute Care)