Michael Jiovanni Elliott, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60511930 Issued in WA

Practice address

420 Legends Way
Bennett Clinic
Fort Cavazos, TX 76544

Phone

(254) 285-5624

Fax

(254) 618-8135

NPI assigned

Nov 12, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Michael Elliott Former name

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Tacoma Emergency Care Physicians, PLLC

  • Emergency Medicine Physician
  • Tacoma, WA
  • NPI 1770823791
  Medicare reassignment
• Western Washington Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Parkland, WA
  • NPI 1801352505
  Medicare reassignment
• Tacoma Emergency Care Physicians, PLLC

  • Emergency Medicine Physician
  • Tacoma, WA
  • NPI 1073854766
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1154727501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 LEGENDS WAY",
            "address_2": "BENNETT CLINIC",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-285-5624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 LEGENDS WAY",
            "address_2": "BENNETT CLINIC",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-285-5624",
            "fax_number": "254-618-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "MICHAEL",
        "middle_name": "JIOVANNI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-12",
        "last_updated": "2025-06-06",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60511930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "ELLIOTT",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shannen Lynn Dumond, RN, MSN, CPNP
• Dallin Lyman Duncan, DDS
• James Dungca, M.D.
• Toritsetimiyin Marian E-Nunu, M.D., MPH
• Jenifer Elizabeth Edmondson, MD
• Christine Lynn Ellis, APRN
• Oriana V Ellis, MD
• Brandon S Emonds, DO
• Jada Renee Epps
• Aaron Esplin, DDS

• Physician Assistant in Fort Cavazos, TX
• Providers in Fort Cavazos, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.