Physician Compare National (NPI:1568510212)

HEALTHCARE PROVIDER: TIMOTHY ANDREW ELLSWORTH PSY.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1568510212
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092812164
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070524000290
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELLSWORTH
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	ANDREW
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1700 CONNECTICUT NWAVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 401
	Group Practice or individual's line 2 address
City	WASHINGTON
	Group Practice or individual's city
State	DC
	Group Practice or individual's state
Zip Code	200091169
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2029661111
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M