Individual provider Active NPI

John Steven Ellis Jr., FNP

  • Family Nurse Practitioner
  • Huntersville, NC
National Provider Identifier
1093407371
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5018142 Issued in NC
Practice address
13835 Boren St
Huntersville, NC 28078-6476
Phone
(704) 912-2222
NPI assigned
May 24, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F05230248 NC
Family Nurse Practitioner 363LF0000X 5018142 NC Primary

Addresses

Primary practice location

13835 Boren St
Huntersville, NC 28078-6476

Mailing address

8911 N Capital of Texas Hwy Ste 1110
Austin, TX 78759-7203

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230609002939 NC Practitioner - Nurse Practitioner 3375900186 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Eldercare PAGroup PAC ID 0648184705, 236 clinicians
Curana Health of North Carolina PLLCGroup PAC ID 1850774332, 274 clinicians

Practice addresses (Care Compare)

4692 Brownsboro Rd
Winston Salem, NC 27106-3410
Phone (336) 251-1114

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5018142NCMDFamily Nurse Practitioner
F05230248NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Curana Health of North Carolina PLLC CurrentSince Jun 14, 2023 Accepting new patients
Physicians Eldercare PA CurrentSince Jun 14, 2023 Accepting new patients

Locations

1509 Dulles Dr
Lafayette, LA 70506
Phone (337) 408-0803

5306 NC Highway 55
Ste 105
Durham, NC 27713
Phone (919) 457-1517

4692 Brownsboro Rd
Winston Salem, NC 27106
Phone (336) 251-1114

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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.

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": "1684886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1093407371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8911 N CAPITAL OF TEXAS HWY STE 1110",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787597203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13835 BOREN ST",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280786476",
            "telephone_number": "704-912-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JOHN",
        "middle_name": "STEVEN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "F05230248",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5018142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntersville, NC

Sources for this page

Verify at the official NPI Registry.