NPIMap

Individual provider Active NPI

Holly Marie Ellis, DO

  • Student in an Organized Health Care Education/Training Program
  • Zionsville, IN
National Provider Identifier
1215673793
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
11022582A Issued in IN
Practice address
6509 Kingsbury Way
Zionsville, IN 46077-8259
Phone
(317) 408-2816
NPI assigned
May 9, 2022
Last updated
Jul 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Student in an Organized Health Care Education/Training Program 390200000X 11022582A IN Primary

Addresses

Primary practice location

6509 Kingsbury Way
Zionsville, IN 46077-8259

Mailing address

6509 Kingsbury Way
Zionsville, IN 46077-8259
Phone (317) 408-2816

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250813000859 MN Practitioner - Family Practice 2163805805 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

11269 Jefferson Hwy N
Champlin, MN 55316-3123
Phone (763) 236-0600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Aug 25, 2025 Accepting new patients
Allina Health System CurrentSince Aug 25, 2025 Accepting new patients
NPI 1083910871 Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

11269 Jefferson Hwy N
Champlin, MN 55316
Phone (763) 236-0600

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

Interoperability endpoints

  • Direct secure messaging: hellis740949@excellian.direct.allina.com

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 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1652054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1215673793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6509 KINGSBURY WAY",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460778259",
            "telephone_number": "317-408-2816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6509 KINGSBURY WAY",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460778259",
            "telephone_number": "317-408-2816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "HOLLY",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-09",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11022582A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Zionsville, IN

Sources for this page

Verify at the official NPI Registry.