DR. CARL RICHARD ELLIS (ED.D.) – Clinical Child & Adolescent Psychologist, NPI 1821173519
Clinical Child & Adolescent Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
667 CLINICAL PSYCHOLOGIST in VA
Provider Addresses for DR. CARL RICHARD ELLIS (ED.D.)
4101 GRANBY ST STE 301
NORFOLK, VA 235041117
Phone: (757) 640-1882
Fax: (757) 640-0253
Type: Location
4101, Granby Street, Riverview, Norfolk, Virginia, 23504, United States
SUITE 301
NORFOLK, VA 235041117
Phone: (757) 640-1882
Fax: (757) 640-0253
Type: Mailing
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.
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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: 2015-01-07
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 |
|---|---|---|---|---|
| I20150107000675 | I | Psychologist Billing Independently | VA | 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 23504)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | VA |
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