Active NPI
Panayiotis A Ellinas II, MD, MPH
- General Practice Physician
- Douglas, AZ
National Provider Identifier
1154322741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 23114
- Practice address
- 100 E 5TH St
CQCH Billing Dept
Douglas, AZ 85607-2859 - Phone
- (520) 364-7659
- NPI assigned
- Aug 3, 2005
- Last updated
- Jul 31, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 23114 | AZ | Primary |
Addresses
Primary practice location
100 E 5TH St
CQCH Billing Dept
Douglas, AZ 85607-2859
Mailing address
101 Cole Ave
CQCH Billing Dept
Bisbee, AZ 85603-1327
Phone (520) 432-6452
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 322214 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nextcare Arizona I JV LLC | Past | Accepting new patients | |
| Chiricahua Community Health Centers, Inc. | Past | Accepting new patients | |
| Pinnacle Medicine Inc. | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Willcox Clinic
- Federally Qualified Health Center (FQHC)
- Willcox, AZ
- NPI 1285488866
-
- Urgent Care Clinic/Center
- Tempe, AZ
- NPI 1114798071
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438300800000",
"number": "1154322741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 COLE AVE",
"address_2": "CQCH BILLING DEPT",
"city": "BISBEE",
"state": "AZ",
"postal_code": "856031327",
"telephone_number": "520-432-6452",
"fax_number": "520-432-8018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E 5TH ST",
"address_2": "CQCH BILLING DEPT",
"city": "DOUGLAS",
"state": "AZ",
"postal_code": "856072859",
"telephone_number": "520-364-7659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLINAS",
"first_name": "PANAYIOTIS",
"middle_name": "A",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "MD, MPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-03",
"last_updated": "2015-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "AZ",
"license": "23114",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "322214",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Douglas, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.