Mark Gregory Ellis, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G65432 Issued in CA

Practice address

2200 Tydd St
Eureka, CA 95501-1284

Phone

(707) 269-7051

Fax

(707) 269-7054

NPI assigned

Jun 27, 2005

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Open Door Community Health Centers

  dba Del Norte Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Crescent City, CA
  • NPI 1497840656
  Medicare reassignment NPD
• Open Door Community Health Centers

  dba Ferndale Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Ferndale, CA
  • NPI 1598178915
  NPD
• Open Door Community Health Centers

  dba Open Door Downtown

  • Federally Qualified Health Center (FQHC)
  • Eureka, CA
  • NPI 1831713452
  NPD
• Eureka Pediatrics Medical Practice

  dba Eureka Pediatrics McKinleyville Office

  • Pediatric Adolescent Medicine Physician
  • McKinleyville, CA
  • NPI 1669775730
  NPD (past)
• Eureka Pediatrics Medical Practice

  • Pediatric Adolescent Medicine Physician
  • Eureka, CA
  • NPI 1881706380
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1003812744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 9TH ST STE 203",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955216249",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 TYDD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955011284",
            "telephone_number": "707-269-7051",
            "fax_number": "707-269-7054"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 Harris St",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955034809",
            "country_code": "US",
            "telephone_number": "707-445-8416",
            "fax_number": "707-445-4182",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2800 Harris St",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955034809",
            "country_code": "US",
            "telephone_number": "707-445-8416",
            "fax_number": "707-445-4182",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARK",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G65432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zena El Jandali El Rifai, DDS
• Rebecca Noyes Elder, M.S, OTR, L, LCSW
• Victor Eleazar, RN
• Kathleen J Ellion
• Mark David Elliott, LPCC
• Stacey L Ellis
• Elloway & Wonenberg, D.D.S., a Professional Dental Corporation
• David Rama Elson
• Patricia Ely
• Karen Sue Emerson

• Pediatrics Physician in Eureka, CA
• Providers in Eureka, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.