RYAN SCOTT ELLSWORTH, DPM — NPI 1104130574 (Licensed & Credentialed Podiatric Medicine & Surgery Service Providers

CMS-1500 Box 24J / 33a • NPI

1104130574

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

213ES0131X (CMS 48)

Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist, Foot Surgery

Box 32 Service Location & ZIP+4

505 FAIRBURN RD SW STE 100, ATLANTA, GA, 30331-2012

✓ 9-Digit EDI 837 ZIP+4 (30331-2012)

Practice Phone & Referral Fax

(404) 618-6077

Fax: (801) 253-6888

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104130574 (RYAN SCOTT ELLSWORTH, DPM) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104130574` (NPI-1 Individual Practitioner)
Provider / Legal Name	RYAN SCOTT ELLSWORTH, DPM
Plain-English Specialty	Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist, Foot Surgery NUCC Code: `213ES0131X` (N/A)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	505 FAIRBURN RD SW STE 100, ATLANTA, GA, 30331-2012
Practice Telephone / Fax	Tel: (404) 618-6077 \| Fax: (801) 253-6888
Administrative Mailing Address	9980 S 300 W STE 300, SANDY, UT, 84070-3654
Enumeration & Last Sync	Enumerated: 2010-07-28 \| CMS Record Updated: 2024-06-17

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

505 FAIRBURN RD SW STE 100, ATLANTA, GA, 30331-2012

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Plain-English Taxonomy & CMS Crosswalk (213ES0131X)

What Does Taxonomy Code 213ES0131X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 213ES0131X translates to:
"Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist, Foot Surgery"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 48 (Podiatry)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Podiatric Medicine & Surgery Service Providers — Podiatrist, Foot Surgery for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (RYAN SCOTT ELLSWORTH, DPM)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`213E00000X` — Podiatrist Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist	State: NV \| License: `2109` \| Primary: Secondary
`213E00000X` — Podiatrist Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist	State: CA \| License: `E5797` \| Primary: Secondary
`213E00000X` — Podiatrist Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist	State: FL \| License: `PO4406` \| Primary: Secondary
`213E00000X` — Podiatrist Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist	State: GA \| License: `POD001473` \| Primary: Secondary
`213EP1101X` — Podiatrist, Primary Podiatric Medicine Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist, Primary Podiatric Medicine	State: UT \| License: `8400193-0501` \| Primary: Secondary
`213ER0200X` — Podiatrist, Radiology Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist, Radiology	State: UT \| License: `8400193-0501` \| Primary: Secondary
`213ES0000X` — Podiatrist, Sports Medicine Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist, Sports Medicine	State: UT \| License: `8400193-0501` \| Primary: Secondary
`213ES0103X` — Podiatrist, Foot & Ankle Surgery Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist, Foot & Ankle Surgery	State: UT \| License: `8400193-0501` \| Primary: Secondary
`213ES0131X` — Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist, Foot Surgery	State: UT \| License: `8400193-0501` \| Primary: Yes (Primary)

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RYAN SCOTT ELLSWORTH, DPM (NPI #1104130574)