EMILY LAUREN ELLIS (CRNP) – Nurse Practitioner, NPI 1780299123

EMILY LAUREN ELLIS (CRNP) is a healthcare provider. based in Shavertown, Pennsylvania. specializing in NURSE PRACTITIONER. They hold the professional credentials CRNP. They hold a License No. SP022466 (PA). The NPI Number for EMILY LAUREN ELLIS (CRNP) is 1780299123

Main info

Female
6 Years Of Experience
Accepts Medicare Assignment
Name
EMILY LAUREN ELLIS (CRNP)
NPI
1780299123
Phone
(717) 855-7600
Address
1160 LANTERN HILL RD
Enumeration Date
12 September 2020
Last Update Date
28 June 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2020 (6 years ago)
PAC ID
6406264928
Group Practice PAC ID
3476464298
Professional Enrollment ID
I20210422001844
Address ID
PA160665238CR2000XDRXX301

Contacts

Secure Messaging
eketterman430749@direct.geisinger.edu
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness85
Years active:5State licenses:1Other namesUpdated within 12 months

11,473 NURSE PRACTITIONER in PA

Provider Addresses for EMILY LAUREN ELLIS (CRNP)

  • 1160 LANTERN HILL RD

    SHAVERTOWN, PA 187089590

    Phone: (717) 855-7600

    Type: Mailing

  • 680 Blair Mill Road

    Horsham, PA 19044

    Phone: (570) 406-5772

    Type: Location

  • 100 N ACADEMY AVE

    DANVILLE, PA 178224903

    Phone: (570) 271-6144

    Fax: (570) 271-6578

    Type: Mailing

  • 25 CHURCH ST

    WILKES BARRE, PA 187023507

    Phone: (570) 808-3181

    Fax: (570) 808-8996

    Type: Location

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: 2021-04-22

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
I20210422001844INurse PractitionerPATBD

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 18708)

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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: 3476464298View full group profile
NameSpecialtyState
N E U R O L O G YPA
Family PracticePA
Emergency MedicinePA
Family PracticePA
Family PracticePA
Orthopedic SurgeryPA
Physician AssistantPA
Internal MedicineMA
Physician AssistantPA
Orthopedic SurgeryPA

Reviews

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Frequently asked questions

What federal number belongs to EMILY LAUREN ELLIS (CRNP)?
The federal identifier for EMILY LAUREN ELLIS (CRNP) is NPI 1780299123.
Does this profile mean EMILY LAUREN ELLIS (CRNP) is currently active?
Yes — EMILY LAUREN ELLIS (CRNP) appears active in the national provider directory.
Can you summarize EMILY LAUREN ELLIS (CRNP)'s specialty in plain language?
Clinically, the directory lists EMILY LAUREN ELLIS (CRNP) with Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What location metadata exists for EMILY LAUREN ELLIS (CRNP)?
The page summarizes Shavertown, Pennsylvania for EMILY LAUREN ELLIS (CRNP); expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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