EARL EDWARD ELLIS (M.ED., LPA) – Psychologist, NPI 1013111459

EARL EDWARD ELLIS (M.ED., LPA) is a healthcare provider. based in Elizabethtown, Kentucky. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials M.ED., LPA. They hold a License No. 0952 (KY). The NPI Number for EARL EDWARD ELLIS (M.ED., LPA) is 1013111459

Main info

Male
17 Years Of Experience
Accepts Medicare Assignment
Name
EARL EDWARD ELLIS (M.ED., LPA)
NPI
1013111459
Phone
(270) 234-9236
Address
890 RINEYVILLE RD
Enumeration Date
11 June 2007
Last Update Date
29 August 2013

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5023612301
Graduation Year
2009 (17 years ago)
PAC ID
1557608866
Group Practice PAC ID
0840180816
Professional Enrollment ID
I20190124001944
Address ID
KY402151130LO1800XAVEX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience50
Completeness75
Years active:18State licenses:1Digital endpointsOther names

253 CLINICAL PSYCHOLOGIST in KY

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Provider Addresses for EARL EDWARD ELLIS (M.ED., LPA)

  • 890, Rineyville Road, Elizabethtown, Hardin County, Kentucky, 42701, United States

    ELIZABETHTOWN, KY 427018927

    Phone: (270) 234-9236

    Fax: (270) 234-8367

    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: 2019-01-24

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
I20190124001944IClinical PsychologistKYTBD

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 42701)

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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: 0840180816View full group profile
NameSpecialtyState
-KY
Endocrinology, Internal MedicineKY
O P H T H A L M O L O G YKY
D E N T I S TFL
Nurse PractitionerKY
Occupational Therapist In Private PracticeIN
N E U R O L O G YKY
Nurse PractitionerKY
Nurse PractitionerKY
Registered Dietitian Or Nutrition ProfessionalKY

Reviews

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Frequently asked questions

What number should I use to identify EARL EDWARD ELLIS (M.ED., LPA) for billing?
Administrative and clinical systems typically use NPI 1013111459 for EARL EDWARD ELLIS (M.ED., LPA).
Does the public listing show EARL EDWARD ELLIS (M.ED., LPA) as active?
EARL EDWARD ELLIS (M.ED., LPA)'s NPI record reflects an active status in NPPES.
What type of care does EARL EDWARD ELLIS (M.ED., LPA) provide?
EARL EDWARD ELLIS (M.ED., LPA)'s profile centers on Psychologist. Clinical services aligned with this taxonomy classification.
Is EARL EDWARD ELLIS (M.ED., LPA) tied to Elizabethtown, Kentucky?
If you are local to Elizabethtown, Kentucky, EARL EDWARD ELLIS (M.ED., LPA) may be relevant to your search.
Why is information missing for EARL EDWARD ELLIS (M.ED., LPA)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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