Dunk A. Ellis III, MD
Individual provider Active NPI Family Medicine Physician · Moss Point, MS
NPI 1043342322 · NPPES record last updated Jan 6, 2020
Key facts
- NPI
- 1043342322
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 12710 (MS)
- Practice address
- 3736 Main St
Moss Point, MS 39563-5108 - Phone
- (228) 474-2212
- Fax
- (228) 475-6271
- NPI assigned
- Mar 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Meharry Medical College School of Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3736 Main St
Moss Point, MS 39563-5108
Phone (228) 474-2212
Hospital & facility affiliations
- Singing River Health System
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040922000361 | MS | Practitioner - Family Practice | 2769450204 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pas-Point Family Clinic, LLC | Family Medicine | Current |
Accepting new patients |
| Pas-Point Family Clinic | Family Medicine | Past |
Accepting new patients |
Locations
3736 Main St
Moss Point, MS 39563
Phone (228) 474-2212
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 12710 | MS | Yes |
Addresses
Primary practice location
3736 Main St
Moss Point, MS 39563-5108
Mailing address
3736 Main St
Moss Point, MS 39563-5108
Phone (228) 474-2212
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00113221 | Medicaid | MS |
Other providers in Moss Point, MS
- Cody McPhail Drummond
- Katherine Drummond
- Clarence E. Dubose Sr.
- Billy Dycus Jr.
- Jessica Eaton
- Emmanuel Transit, LLC
- Calvin S Ennis
- F T Inc
- Family Care Center LLC
- Family Care Center LLC
All providers in Moss Point, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.