Jonathan Matthew Ellis, B.S., D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

823 Issued in WV

Practice address

123 Market St
Man, WV 25635-1216

Phone

(304) 688-1204

NPI assigned

Jul 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jonathan.ellis.1@21756.direct.athenahealth.com

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.

• Logan Mingo Area Mental Health Inc

  • Primary Care Clinic/Center
  • Logan, WV
  • NPI 1427522218
  Medicare reassignment NPD
• Logan-Mingo Area Mental Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Logan, WV
  • NPI 1598396202
  NPD
• Every Bodys Chiropractic PLLC

  • Chiropractor
  • Kingwood, WV
  • NPI 1821181132
  NPD (past)
• Mountain State Chiropractic

  • Chiropractor
  • Man, WV
  • NPI 1366501447
  NPD (past)

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1083634026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 MARKET ST",
            "city": "MAN",
            "state": "WV",
            "postal_code": "256351216",
            "telephone_number": "304-688-1204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 MARKET ST",
            "city": "MAN",
            "state": "WV",
            "postal_code": "256351216",
            "telephone_number": "304-688-1204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JONATHAN",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "B.S., D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WV",
            "license": "823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "4-MOST",
            "identifier": "113708911",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEIA",
            "identifier": "113708911",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "113708911",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "13708911",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACCORDIA",
            "identifier": "113708911",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001425",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKER'S COMP",
            "identifier": "1067067",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARELINK",
            "identifier": "113708911",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STARMARK",
            "identifier": "11378911",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHEILD",
            "identifier": "001705988",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARRINGTON BENEFITS",
            "identifier": "113708911",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "92064",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Wilson Gene Evans
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• Crystal Dawn Gibson
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• Chiropractor in Man, WV
• Providers in Man, WV by specialty
• Chiropractor in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.