Shannon Scott Ellis, MD
Individual provider Active NPI Family Medicine Physician · Hoschton, GA
NPI 1124219563 · NPPES record last updated Oct 6, 2020
Key facts
- NPI
- 1124219563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 072568 (GA)
- Practice address
- 26 W Jackson Commons Dr
Hoschton, GA 30548-1897 - Phone
- (706) 658-2452
- NPI assigned
- Aug 8, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- East Tennessee State University Quillen College of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Northeast Georgia Physicians Group Inc
Northeast Georgia Physicians Group Urgent Care LLC
Practice addresses (Care Compare)
26 W Jackson Commons Dr
Hoschton, GA 30548-1897
Phone (706) 658-2452
597 S Enota Dr NE
Gainesville, GA 30501-2545
Phone (770) 219-7777
852 Dacula Rd
Dacula, GA 30019-3185
Phone (770) 848-9381
PO Box
Suite 1060
Oakwood, GA 30566-0018
Hospital & facility affiliations
- Amedisys Home Health of Covington
- Pruitthealth at Home - Atlanta
- Northeast Georgia Medical Center, Inc
- NGMC Barrow, LLC
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.83 of 100
- Quality
- 80.36
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 79.08
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140911002200 | GA | Practitioner - Family Practice | 8022161082 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Georgia Physicians Group Inc | Family Medicine | Current |
Accepting new patients |
| Rural Urgent Care LLC | Current |
Accepting new patients | |
| Rural Urgent Care LLC | Family Medicine | Current |
Accepting new patients |
| Carolinas Physicians Network Inc | Past | Accepting new patients | |
| Novant Medical Group, Inc. | Past | Accepting new patients | |
| Onslow Ambulatory Services, Inc | Family Medicine | Past | Accepting new patients |
Locations
1925 W Main St
#120
Centre, AL 35960
Phone (256) 677-4552
1515 River Pl
Ste 100
Braselton, GA 30517
Phone (770) 848-6195
852 Dacula Rd
Dacula, GA 30019
Phone (770) 848-9360
597 S Enota Dr NE
Gainesville, GA 30501
Phone (770) 219-8275
26 W Jackson Commons Dr
Hoschton, GA 30548
Phone (706) 658-2452
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 072568 | GA | Yes |
| Family Medicine Physician | 207Q00000X | 2007-01049 | NC |
Addresses
Primary practice location
26 W Jackson Commons Dr
Hoschton, GA 30548-1897
Mailing address
PO Box 742616
Atlanta, GA 30374-2616
Phone (770) 219-8420
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5912656 | Medicaid | NC |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sellis29464@nghs.gadirect.net | Direct |
Other providers in Hoschton, GA
- Bryan Diaz-Rodriguez
- Divine Home Health Services LLC
- Tandi Dubnik
- Adam James Dunton
- Zachary Elison
- Ama Konadu Ennison
- Sammy Ennison
- Ennisons Homecare LLC
- Charlotte Hart Fandrich
- First Look MRI, LLC
All providers in Hoschton, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.