NPIMap

Individual provider Active NPI

Jennifer T Ellis, MD

  • Family Medicine Physician
  • Simpsonville, SC
National Provider Identifier
1083641757
Registry record updated Aug 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
24518 Issued in SC
Practice address
717 SE Main St
Simpsonville, SC 29681-3237
Phone
(864) 522-5400
Fax
(864) 522-5405
NPI assigned
Jun 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 24518 SC Primary

Addresses

Primary practice location

717 SE Main St
Simpsonville, SC 29681-3237

Mailing address

1 Independence PT Ste 212
Greenville, SC 29615-4536
Phone (864) 797-6308

Other identifiers 1

IdentifierTypeStateIssuer
245185MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031215000099 SC Practitioner - Family Practice 4385541804 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, San Diego School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prisma Health University Medical GroupGroup PAC ID 8325950983, shared by 5 NPIs, 2,467 clinicians

Practice addresses (Care Compare)

717 SE Main St
Simpsonville, SC 29681-3237
Phone (864) 522-5400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
GHS Partners in Health, Inc. Family Medicine CurrentSince Dec 9, 2015 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Prisma Health University Medical Group CurrentSince Dec 9, 2015 Accepting new patients
Prisma Health University Medical Group Family Medicine CurrentSince Oct 1, 2016 Accepting new patients
St Francis Physician Services Inc Family Medicine Past Accepting new patients
St Francis Physician Services Inc Family Medicine Past Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

3909 S Highway 14
Greenville, SC 29615
Phone (864) 522-1320

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

717 SE Main St
Simpsonville, SC 29681
Phone (864) 522-5400

717 SE Main St
Bldg A
Simpsonville, SC 29681
Phone (864) 522-5400

Interoperability endpoints

  • Direct secure messaging: jellis50178@direct.ghs.myhfn.org

Organizations & group practices 6

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 53

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

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502755200000",
    "number": "1083641757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT STE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154536",
            "telephone_number": "864-797-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 SE MAIN ST",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296813237",
            "telephone_number": "864-522-5400",
            "fax_number": "864-522-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JENNIFER",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2017-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "24518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "245185",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Simpsonville, SC

Sources for this page

Verify at the official NPI Registry.