Individual provider Active NPI

Stefanie R Ellison, M.D.

  • Emergency Medicine Physician
  • Kansas City, MO
National Provider Identifier
1053372904
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
112705 Issued in MO
Practice address
2301 Holmes St
Kansas City, MO 64108-2640
Phone
(816) 404-1536
NPI assigned
Mar 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 112705 MO Primary

Addresses

Primary practice location

2301 Holmes St
Kansas City, MO 64108-2640

Mailing address

2310 Holmes St
Ste 800
Kansas City, MO 64108-2634

Other identifiers 1

IdentifierTypeStateIssuer
203987409MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20100816000744 MO Practitioner - Emergency Medicine 3173657970 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Nebraska College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Health PhysiciansGroup PAC ID 1153235825, 344 clinicians

Practice addresses (Care Compare)

2301 Holmes St
Kansas City, MO 64108-2640
Phone (816) 404-1000

Hospital & facility affiliations

  • Truman Medical Center Hospital Hill Hospital, Kansas City, MO, CCN 260048

Merit-based Incentive Payment System (MIPS)

Final score
86.53 of 100Reported as group
Quality
59.66
Promoting interoperability
100
Improvement activities
40
Cost
74.66

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
112705MOMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Health Physicians Emergency Medicine CurrentSince Jul 1, 2000 Accepting new patients

Locations

2301 Holmes St
Kansas City, MO 64108

7900 Lees Summit Rd
Kansas City, MO 64139
Phone (816) 373-4485

2310 Holmes St
Ste 800
Kansas City, MO 64108
Phone (816) 218-2500

4407 E 50th Ter
Kansas City, MO 64130
Phone (816) 924-1201

Interoperability endpoints

  • Direct secure messaging: stefanie.ellison@direct.tmcmed.org

Organizations & group practices 1

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1053372904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 HOLMES ST",
            "address_2": "STE 800",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641082634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 HOLMES ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641082640",
            "telephone_number": "816-404-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "STEFANIE",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-30",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "112705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203987409",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.