NPIMap

Organization Active NPI

Jeri Ellis MD MPH PC

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1043361934
Registry record updated May 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20048 Issued in OK
Legal business name
JERI ELLIS MD MPH PC
Practice address
5835 S Pennsylvania Ave
Oklahoma City, OK 73119-7001
Phone
(405) 816-3311
Fax
(405) 634-7577
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2014

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

Authorized official

Name
Jeri Ellis, M.D.
Title
Owner
Phone
(405) 604-9595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 20048 OK Primary

Addresses

Primary practice location

5835 S Pennsylvania Ave
Oklahoma City, OK 73119-7001

Mailing address

5835 S Pennsylvania Ave
Oklahoma City, OK 73119-7001
Phone (405) 816-3311

Other identifiers 3

IdentifierTypeStateIssuer
569535528001OtherOKBCBS
200049610AMedicaidOK
200075590BMedicaidOK

National Provider Directory

National Provider Directory

Locations

5835 S Pennsylvania Ave
Oklahoma City, OK 73119
Phone (405) 604-9595

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398988800000",
    "number": "1043361934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5835 S PENNSYLVANIA AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731197001",
            "telephone_number": "405-816-3311",
            "fax_number": "405-634-7577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5835 S PENNSYLVANIA AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731197001",
            "telephone_number": "405-816-3311",
            "fax_number": "405-634-7577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERI ELLIS MD MPH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2014-05-02",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JERI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-604-9595",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "20048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "569535528001",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200049610A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200075590B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.