KENNETH ROBERT ELLISON (PA) – Medical Physician Assistant, NPI 1831122803
Medical Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
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Provider Addresses for KENNETH ROBERT ELLISON (PA)
1032, Mar Walt Drive, Wright, Fort Walton Beach, Okaloosa County, Florida, 32547, United States
SUITE 250
FORT WALTON BEACH, FL 325476661
Phone: (850) 863-3463
Fax: (850) 315-6051
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)
CMS reports 2 Open Payments records for all available years, with a total value of $178.
Total Amount is formed as General ($178) + Research ($0) + Ownership ($0) = $178.
Last reported payment date: 2024-06-19 • Largest payer in this snapshot: Abbott Laboratories ($129).
Total Amount
$178
General + Research + Ownership
Payments
2
Total payment records
General Amount
$178
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $129 |
| Boston Scientific Corporation | $48 |
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: 2012-11-14
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20121114000369 | I | Physician Assistant | FL | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 75 | 54 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 56 | 56 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 21 | 19 | $0 |
Insurance plans in this area (ZIP 32547)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | FL | |
| Pulmonary Disease, Critical Care (Intensivists) | NY | |
| Infectious Disease | FL | |
| P O D I A T R Y | FL | |
| R H E U M A T O L O G Y | WI | |
| Nurse Practitioner | FL | |
| Infectious Disease, Internal Medicine | FL | |
| Critical Care (Intensivists), Pulmonary Disease | FL | |
| Infectious Disease, Internal Medicine | IL | |
| Infectious Disease | GA |
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