Tina Marlene Ellis, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2889 Issued in SC

Practice address

4969 Centre Pointe Dr
Ste 100
North Charleston, SC 29418-6952

Phone

(843) 853-0250

Fax

(843) 606-8103

NPI assigned

Nov 5, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Medical University of South Carolina College of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Carolina Multispecialty Associates LLCGroup PAC ID 9931105046, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trident Medical Center Hospital, Charleston, SC, CCN 420079
• Roper Hospital Hospital, Charleston, SC, CCN 420087
• Roper St Francis Hospital-Berkeley Inc Hospital, Summerville, SC, CCN 420110

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

99

Improvement activities

40

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tina.ellis@hca5.eclinicaldirectplus.com

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.

• Coastal Carolina Multispecialty Associates, LLC

  dba Coastal Carolina Surgical Specialists

  • Specialist
  • Summerville, SC
  • NPI 1518079102
  Medicare reassignment Care Compare group
• Coastal Carolina Multispecialty Assocs, LLC

  • Specialist
  • North Charleston, SC
  • NPI 1184730749
  NPD (past)
• Cardiovascular Consultants LTD

  • Medical Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1023073525
  NPD (past)

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

• Roper Hospital, Inc

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1962472860
  Care Compare affiliation
• Roper St Francis Hospital-Berkeley Inc.

  dba Roper St. Francis Intensivist Services

  • General Acute Care Hospital
  • Summerville, SC
  • NPI 1336603646
  Care Compare affiliation
• Trident Medical Center, LLC

  dba HCA Healthcare Trident Hospital

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1366496937
  Care Compare affiliation

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1053648436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4969 CENTRE POINTE DR",
            "address_2": "STE 100",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294186952",
            "telephone_number": "843-853-0250",
            "fax_number": "843-606-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4969 CENTRE POINTE DR",
            "address_2": "STE 100",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294186952",
            "telephone_number": "843-853-0250",
            "fax_number": "843-606-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "TINA",
        "middle_name": "MARLENE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-05",
        "last_updated": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "2889",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4750017",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TINA.ELLIS@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "4969 Centre Pointe Dr",
            "address_2": "STE 100",
            "city": "North Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294186952",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Ellis
• Kara Lapin Ellis, FNP
• Kierstan Ellis
• Sophie Ellis, ED.S.
• Tara Russell Ellis, NP
• Christine Ellison
• Zana Elmaasarani, PHARMD
• Elms Digestive Disease Specialists,PA
• Elms Endoscopy Center LLC (Elms Endoscopy Center)
• Abdulrahman Jamal Elwir, MD

• Physician Assistant in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.