Individual provider Active NPI

David J Ellingson, P.A.

  • Surgical Physician Assistant
  • Tavares, FL
National Provider Identifier
1144228685
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9102690 Issued in FL
Practice address
3310 Waterman Way
Tavares, FL 32778-5250
Phone
(352) 343-1216
Fax
(352) 343-1582
NPI assigned
Jul 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA9102690 FL Primary

Addresses

Primary practice location

3310 Waterman Way
Tavares, FL 32778-5250

Mailing address

PO Box 935921
Atlanta, GA 31193-5921

Other identifiers 1

IdentifierTypeStateIssuer
291796300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20040420000264 FL Practitioner - Physician Assistant 0547255309 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Healthcare Partners, IncGroup PAC ID 7012266836, 621 clinicians

Practice addresses (Care Compare)

1000 Waterman Way
Tavares, FL 32778-5266
Phone (352) 742-3581

60 Memorial Medical Pkwy
Palm Coast, FL 32164-5980
Phone (386) 586-2000

Hospital & facility affiliations

  • Adventhealth Waterman Hospital, Tavares, FL, CCN 100057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9102690FLMDSurgical Physician Assistant
999999GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc CurrentSince Nov 9, 2011 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Nov 9, 2011 Accepting new patients
Peachtree Cardiovascular Surgeons at Saint Joseph'S LLC Past Accepting new patients
Peachatree Cardiovascular & Thoracic Surgeons, P.a. PastSince Jul 23, 1992 Accepting new patients
Cardiovascular Surgeons, P.a. PastSince Oct 16, 1995 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

217 Hillcrest St
Orlando, FL 32801
Phone (407) 425-1566

60 Memorial Medical Pkwy
Palm Coast, FL 32164
Phone (385) 586-2000

1749 David Walker Dr
Tavares, FL 32778
Phone (352) 742-1760

3120 Waterman Way
Tavares, FL 32778
Phone (352) 253-3251

3310 Waterman Way
Tavares, FL 32778
Phone (352) 343-1216

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: dellingson72055@adventhealth.direct-ci.com

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 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": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1144228685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 935921",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311935921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 WATERMAN WAY",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785250",
            "telephone_number": "352-343-1216",
            "fax_number": "352-343-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9102690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291796300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tavares, FL

Sources for this page

Verify at the official NPI Registry.