NPIMap

Individual provider Active NPI

Reuben Kristian Ellis, M.D.

  • Nephrology Physician
  • Macon, GA
National Provider Identifier
1114969110
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
055819 Issued in GA
Practice address
1425 Georgia Ave Ste 201a
Macon, GA 31201-6546
Phone
(478) 250-1325
NPI assigned
Jun 12, 2006
Last updated
Nov 19, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 055819 GA Primary

Addresses

Primary practice location

1425 Georgia Ave Ste 201a
Macon, GA 31201-6546

Mailing address

PO Box 6612
Macon, GA 31208-6612
Phone (478) 250-1325

Other practice location 1

791 Poplar St
Macon, GA 31201-2045
Phone (404) 877-8115

Other practice location 2

1445 Georgia Ave Ste 3
Macon, GA 31201-7612
Phone (478) 250-1325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20050616000318 GA Practitioner - NephrologyPractitioner - Internal Medicine 7911941398 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Alabama School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1425 Georgia Ave
Suite 201a
Macon, GA 31201-6546
Phone (478) 250-1325

1445 Georgia Avevue
Suite 1
Macon, GA 31201-7614
Phone (478) 250-1325

1570 Watson Blvd
Warner Robins, GA 31093-3474
Phone (478) 250-1325

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.49 of 100Reported as individual
Quality
43.39
Improvement activities
40
Cost
87.87

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23555ALMDPharmacist
055819GAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Consultants of Georgia Warner Robins LLC Nephrology CurrentSince Nov 10, 2020 Accepting new patients
Physician Consultants of Georgia Interventional LLC CurrentSince Oct 25, 2013 Accepting new patients
Talis Healthcare LLC CurrentSince Dec 20, 2023 Accepting new patients
Midtown Infusion Center CurrentSince Jul 30, 2016 Accepting new patients
Physician Consultants of Georgia Nephrology CurrentSince Jun 14, 2012 Accepting new patients
Madalyn N. Davidoff, M.D., LLC PastSince Jan 8, 2021 Accepting new patients
Southern Medical Group, Inc Past Accepting new patients
Guardian Medical Services, LLC Past Accepting new patients
BHC - Montclair Hospitalist PastSince Aug 1, 2001 Accepting new patients
Dublin Kidney Institute PastSince Sep 22, 2017 Accepting new patients
Baptist Health System, Inc. PastSince Apr 1, 1996 Accepting new patients
Macon Kidney Institute Nephrology Past Accepting new patients

Locations

207 Industrial Blvd
Dublin, GA 31021
Phone (478) 353-3044

1425 Georgia Ave
Ste 201
Macon, GA 31201
Phone (478) 250-9875

1425 Georgia Ave
Ste 201A
Macon, GA 31201
Phone (478) 250-1325

1425 Georgia Ave
Ste 201B
Macon, GA 31201
Phone (478) 250-1325

1445 Georgia Ave
Ste 1
Macon, GA 31201
Phone (478) 250-1325

1445 Georgia Ave
Ste 2
Macon, GA 31201
Phone (478) 250-1325

1445 Georgia Ave
Ste 3
Macon, GA 31201
Phone (478) 250-1325

1570 Watson Blvd
Warner Robins, GA 31093
Phone (478) 250-1325

7501 Fannin St
Ste 900A
Houston, TX 77054
Phone (321) 888-2523

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FEADBD/Endpoint/FEADBD
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHIIBA/Endpoint/IHIIBA
  • Direct secure messaging: rellis433576@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 12

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 11

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1114969110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6612",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312086612",
            "telephone_number": "478-250-1325",
            "fax_number": "478-254-6860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 GEORGIA AVE STE 201A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016546",
            "telephone_number": "478-250-1325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "791 Poplar St",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312012045",
            "country_code": "US",
            "telephone_number": "404-877-8115",
            "fax_number": "678-376-9182",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1445 Georgia Ave Ste 3",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312017612",
            "country_code": "US",
            "telephone_number": "478-250-1325",
            "fax_number": "478-254-6860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "REUBEN",
        "middle_name": "KRISTIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "055819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.