KIRSTEN ELLIS (CRNA) – Certified Registered Nurse Anesthetist, NPI 1417794686

KIRSTEN ELLIS (CRNA) is a healthcare provider. based in Los angeles, California. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. 95002604 (CA). The NPI Number for KIRSTEN ELLIS (CRNA) is 1417794686

Main info

Female
Sole Proprietor
2 Years Of Experience
Accepts Medicare Assignment
Name
KIRSTEN ELLIS (CRNA)
NPI
1417794686
Phone
(323) 321-3764
Address
721 W 111TH ST
Enumeration Date
13 July 2024
Last Update Date
23 July 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9517844088
Graduation Year
2024 (2 years ago)
PAC ID
8921506775
Group Practice PAC ID
9436520814
Professional Enrollment ID
I20250811002393
Address ID
CA925014006RI4500XAVEX302
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience35
Completeness85
Years active:1State licenses:2Digital endpointsOther names

2,456 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in CA

Provider Addresses for KIRSTEN ELLIS (CRNA)

  • 721 W 111TH ST

    LOS ANGELES, CA 900444234

    Phone: (323) 321-3764

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-08-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250811002393ICertified Registered Nurse Anesthetist (Crna)CATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 90044)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9436520814View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)CA
Certified Registered Nurse Anesthetist (Crna)DC

Reviews

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Frequently asked questions

How is KIRSTEN ELLIS (CRNA) identified in CMS data?
CMS-hosted NPPES data lists KIRSTEN ELLIS (CRNA) with NPI 1417794686.
Can I rely on KIRSTEN ELLIS (CRNA) being an active provider?
As of the registry snapshot, KIRSTEN ELLIS (CRNA) is marked active.
What is KIRSTEN ELLIS (CRNA) best known for clinically?
Directory data describes KIRSTEN ELLIS (CRNA) with Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
Does KIRSTEN ELLIS (CRNA) list a practice location?
Patients near Los Angeles, California may find KIRSTEN ELLIS (CRNA) in results; validate coverage separately.
Is the information about KIRSTEN ELLIS (CRNA) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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