Robert S Ellis, MD

Primary specialty

Trauma Surgery PhysicianTaxonomy code 2086S0127X

License

M1656 Issued in TX

Practice address

910 E Houston St
Ste 530
Tyler, TX 75702-8369

Phone

(903) 531-5560

NPI assigned

Jan 9, 2007

Sex

Male

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 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Specialty

General Surgery

Education

Temple University School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Conroe Montgomery Physicians Group, PLLCGroup PAC ID 1850547365, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Houston Healthcare Conroe Hospital, Conroe, TX, CCN 450222

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: conroe.coccr.txa@ccda.hcadirect.net

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.

• Conroe Montgomery Physicians Group, PLLC

  • Family Medicine Physician
  • Conroe, TX
  • NPI 1518220094
  Medicare reassignment Care Compare group NPD
• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• Mother Frances Hospital Regional Health Care Center

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  NPD (past)
• Norumbega Medical Specialists, LTD

  • Health Service Clinic/Center
  • Brewer, ME
  • NPI 1780821140
  NPD (past)

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

• Chca Conroe LP

  • General Acute Care Hospital
  • Conroe, TX
  • NPI 1962455816
  Care Compare affiliation

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1093864027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 E HOUSTON ST",
            "address_2": "STE 530",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028369",
            "telephone_number": "903-531-5560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ROBERT",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "TX",
            "license": "M1656",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "TX",
            "license": "M1656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "TIN PLUS 096",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178944801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "86515S",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "8BC264",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CONROE.COCCR.TXA@CCDA.HCADIRECT.NET",
            "affiliation": "N",
            "address_1": "910 E Houston St",
            "address_2": "STE 530",
            "city": "Tyler",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757028369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Graham Ellis, MD
• Jaishree Riva Ellis, MD
• Kristin Ellis
• Leslee Ellis
• Melissa Ellis
• Scott Ellis, DDS
• Sherrie Ellis
• Theresa Ellis
• Yanique Tavia Ellis, MD
• Kara Elaine Ellison, PA

• Trauma Surgery Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Trauma Surgery Physician in Texas

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