NPIMap

Individual provider Active NPI

Ellen Marie Dejong, MD

  • Anesthesiology Physician
  • Truckee, CA
National Provider Identifier
1154711836
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A151834 Issued in CA
Practice address
10121 Pine Ave
Truckee, CA 96161-4856
Phone
(510) 307-6773
NPI assigned
Feb 2, 2015
Last updated
Jun 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A151834 CA Primary
Pediatrics Physician 208000000X A151834 CA

Addresses

Primary practice location

10121 Pine Ave
Truckee, CA 96161-4856

Mailing address

10 Arch St Apt 204
Redwood City, CA 94062-1402
Phone (510) 307-6773

Other names 1

  • Ellen Ryan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190705000713 CA Practitioner - Pediatric Medicine 5991030439 Reassigns benefits to 2 organizations
I20240913001041 NV Practitioner - Anesthesiology 5991030439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tahoe Forest Hospital DistrictGroup PAC ID 0446161335, shared by 12 NPIs, 140 clinicians

Practice addresses (Care Compare)

10121 Pine Ave
Truckee, CA 96161-4835
Phone (530) 587-6011

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.06 of 100Reported as group
Quality
83.97
Promoting interoperability
88
Improvement activities
40
Cost
42.89

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A151834CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tahoe Forest Hospital District CurrentSince Sep 1, 2023 Accepting new patients
Tahoe Forest Hospital District Current Accepting new patients
Tahoe Forest Hospital District Current Accepting new patients
Tahoe Forest Hospital District CurrentSince Sep 1, 2023 Accepting new patients
Tahoe Forest Hospital District Current Accepting new patients

Locations

10051 Lake Ave
Ste 3
Truckee, CA 96161
Phone (530) 587-7461

10121 Pine Ave
Truckee, CA 96161
Phone (530) 582-3220

880 Alder Ave
Incline Vlg, NV 89451
Phone (775) 831-6200

Organizations & group practices 5

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 5

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": "1422835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1154711836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ARCH ST APT 204",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940621402",
            "telephone_number": "510-307-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10121 PINE AVE",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614856",
            "telephone_number": "510-307-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG",
        "first_name": "ELLEN",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-02",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A151834",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A151834",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "RYAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Truckee, CA

Sources for this page

Verify at the official NPI Registry.