RYAN SCOTT ELLSWORTH DPM NPI 1104130574

NPI Information

  • NPI: 1104130574
  • Provider Name: RYAN SCOTT ELLSWORTH, DPM
  • Classification: Podiatrist - 213ES0131X
  • Specialization: Foot Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 505 FAIRBURN RD SW STE 100
    ATLANTA, GA
    ZIP 30331
  • Phone: (404) 618-6077

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NPI Details

Ryan Scott Ellsworth, DPM is a foot surgery podiatrist in Atlanta, GA with 15 years of experience. Ryan Scott Ellsworth, DPM NPI is 1104130574. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

505 FAIRBURN RD SW STE 100
ATLANTA, GA
ZIP 30331-012
Phone: (404) 618-6077
Fax: (801) 253-6888

The NPI 1104130574 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Dermacyte amniotic membrane allograft, per square centimeter (HCPCS:Q4248)
  • Amnioarmor, per square centimeter (HCPCS:Q4188)
  • Detection test by nucleic acid for organism, amplified probe technique (HCPCS:87798)
  • Detection test for candida species (yeast), amplified probe technique (HCPCS:87481)
  • Detection test by nucleic acid for multiple organisms, amplified probe(s) technique (HCPCS:87801)
  • Follow-up nursing facility visit per day, typically 15 minutes (HCPCS:99308)
  • Removal of skin and tissue, 20.0 sq cm or less (HCPCS:11042)
  • Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less (HCPCS:15275)
  • Established patient custodial care facility, group care, or assisted living visit, typically 25 minutes (HCPCS:99335)
  • Detection test by nucleic acid for staphylococcus aureus, methicillin resistant (mrsa bacteria), amplified probe technique (HCPCS:87641)
  • Injection of anesthetic and/or steroid drug into foot nerve (HCPCS:64455)
  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
  • Other procedure on foot or toes (HCPCS:28899)
  • Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
  • Follow-up nursing facility visit per day, typically 25 minutes (HCPCS:99309)
  • Biopsy of fingernail or toenail (HCPCS:11755)

The enumeration date for this NPI number is 7/28/2010 and was last updated on 6/17/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213E00000XPodiatrist2109NEVADANo
2213E00000XPodiatristE5797CALIFORNIANo
3213E00000XPodiatristPO4406FLORIDANo
4213E00000XPodiatristPOD001473GEORGIANo
5213EP1101XPodiatristPrimary Podiatric Medicine8400193-0501UTAHNo
6213ER0200XPodiatristRadiology8400193-0501UTAHNo
7213ES0000XPodiatristSports Medicine8400193-0501UTAHNo
8213ES0103XPodiatristFoot & Ankle Surgery8400193-0501UTAHNo
9213ES0131XPodiatristFoot Surgery8400193-0501UTAHYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11003111MEDICAIDUTAH
28400193-0501OTHERUTAHUT DPM LICENSE
37672880001OTHERUTAHDME
4E5797OTHERCALIFORNIACA DPM LICENSE
5POD001473OTHERGEORGIAGA DPM LICENSE
6PO4406OTHERFLORIDAFL DPM LICENSE
72109OTHERNEVADANV DPM LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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