Jonathan J Ellichman, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

18972 Issued in MS

Practice address

6401 Poplar Ave Ste 410
Memphis, TN 38119-4808

Phone

(901) 259-2718

Fax

(901) 259-1123

NPI assigned

Jul 13, 2006

Last updated

Mar 8, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN, AR2 enrollments

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 2

Specialty

Cardiac SurgeryAlso: Thoracic Surgery, Vascular Surgery

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Cardiovascular PLLCGroup PAC ID 0042388373, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: jellichman@yourcarecommunity.org

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.

• Southern Cardiovascular PLLC

  • Multi-Specialty Clinic/Center
  • Memphis, TN
  • NPI 1447415104

  AR

  Medicare reassignment Care Compare group Authorized official
• Thoracic and Cardiovascular Surgery Association

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Memphis, TN
  • NPI 1356453773
  NPD (past)
• Vascular Access Center of Bolivar County LLC

  dba Endovascular Health Services of Bolivar County

  • Vascular & Interventional Radiology Physician
  • Cleveland, MS
  • NPI 1851620249
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457395200000",
    "number": "1073538823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1779 KIRBY PKWY # 1-511",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381383666",
            "telephone_number": "901-371-5218",
            "fax_number": "901-682-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 POPLAR AVE STE 410",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194808",
            "telephone_number": "901-259-2718",
            "fax_number": "901-259-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLICHMAN",
        "first_name": "JONATHAN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2016-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MS",
            "license": "18972",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "TN",
            "license": "39618",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165449001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30005342",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06336753",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miriam Ellegant, PHARM.D
• Rose C Ellen, MD
• Andrew Mitchell Eller, MD
• John Allan Elli, P.A.-C.
• Leora Jane Elli, PA-C
• Lauren Rai Elliott-Mullens
• Darrell Andrew Elliott, M.D.
• Elizabeth Carolyn Elliott
• Gene Elliott, LMT
• James E Elliott, DDS

• Vascular Surgery Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Vascular Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; 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.