MRS. KELLY ELIZABETH ELLIS (APN, CNM) – Advanced Practice Midwife, NPI 1962705103
Advanced Practice Midwife
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
292 CERTIFIED NURSE MIDWIFE (CNM) in OH
Provider Addresses for MRS. KELLY ELIZABETH ELLIS (APN, CNM)
905 RIVER RD STE C
GRANVILLE, OH 430239560
Phone: (740) 279-3990
Fax: (740) 212-8368
Type: Mailing
124 S Main St Unit A
Granville, OH 430231409
Phone: (740) 279-3990
Fax: (740) 212-8368
Type: Location
6201 ROOSEVELT RD
BERWYN, IL 604021108
Phone: (708) 386-0845
Fax: (708) 386-8472
Type: Mailing
5000 E MAIN ST
COLUMBUS, OH 432132440
Phone: (614) 235-5555
Fax: (614) 536-1994
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $23.
Total Amount is formed as General ($23) + Research ($0) + Ownership ($0) = $23.
Last reported payment date: 2024-04-23 • Largest payer in this snapshot: Lilly USA, LLC ($23).
Total Amount
$23
General + Research + Ownership
Payments
1
Total payment records
General Amount
$23
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-04-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Lilly USA, LLC | $23 |
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: 2026-01-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20130425000671 | I | Certified Nurse Midwife (Cnm) | IL | TBD |
| I20260130001168 | I | Certified Nurse Midwife (Cnm) | OH | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 43023)
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