Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Henry Ellis, AGACNP-BC

Individual provider Acute Care Nurse Practitioner · NPI 1710589486

Henry Ellis, AGACNP-BC is a Nurse Practitioner in Worcester, Massachusetts. Qualified in 2020, 6 years ago. Practices with Umass Memorial Medical Group Inc, a 2,467-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Massachusetts.

Years since qualifying
6
Licensed in
MA
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

55 Lake Ave N
Worcester, MA 01655-0002
Phone: (774) 443-7552
Fax: (774) 441-6086
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 119 Belmont St, Worcester, MA 01605-2903 — (774) 443-7552

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence RN2316112 (MA)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence RN2316112 (MA)

Record details

NPI number1710589486
Entity typeIndividual (Type 1)
GenderMale
Credentials AGACNP-BC
Sole proprietorNo
NPI enumeratedNovember 9, 2020
Last updated in NPPESMarch 27, 2021
Certification dateMarch 27, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Umass Memorial Medical Group Inc — 2467 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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