Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jared Scott Ellsworth, PA

Individual provider Physician Assistant · NPI 1821829821

Jared Scott Ellsworth, PA is a Physician Assistant in Ardmore, Oklahoma. Qualified in 2024, 2 years ago. Practices with Good Shepherd Community Clinic, Inc, a 17-clinician group and accepts Medicare assignment. Licensed in Oklahoma.

Years since qualifying
2
Licensed in
OK
In the registry since
2024
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1104 Walnut Dr
Ardmore, OK 73401-2353
Phone: (580) 223-3411
Fax: (580) 226-2284
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5366 (OK)

Record details

NPI number1821829821
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 12, 2024
Last updated in NPPESAugust 12, 2024
Certification dateAugust 12, 2024
Mailing address1104 Walnut Dr, Ardmore, OK 73401-2353

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Good Shepherd Community Clinic, Inc. — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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