Kenneth R Ellis, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD00041277 Issued in WA

Practice address

1213 24TH St
Suite 300
Anacortes, WA 98221-2592

Phone

(360) 293-2020

Fax

(360) 299-0341

NPI assigned

May 19, 2006

Last updated

Jul 30, 2008By the provider in NPPES

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 identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

University of California, Irvine, California College of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Island Eye Physicians and SurgeonsGroup PAC ID 9537056569, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.15 of 100Reported as group

Quality

99.91

Improvement activities

40

Cost

83.97

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Island Eye Physicians & Surgeons

  • Medical Specialty Clinic/Center
  • Anacortes, WA
  • NPI 1306893755
  Medicare reassignment Care Compare group NPD
• Island Eye Physicians & Surgeons

  • Durable Medical Equipment & Medical Supplies
  • Anacortes, WA
  • NPI 1619033214
  NPD

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217376000000",
    "number": "1215981022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 24TH ST",
            "address_2": "SUITE 300",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212592",
            "telephone_number": "360-293-2020",
            "fax_number": "360-299-0341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 24TH ST",
            "address_2": "SUITE 300",
            "city": "ANACORTES",
            "state": "WA",
            "postal_code": "982212592",
            "telephone_number": "360-293-2020",
            "fax_number": "360-299-0341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KENNETH",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2008-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "MD00041277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8351454",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L AND I",
            "identifier": "0163027",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Echohealth Physical Therapy, P.S.
• Breonna Edwards
• Holle Ann Edwards, SUDP
• Susan L Edwards, MSW, LICSW
• Nicolas Alfonso Elizondo
• Michelle Matson Ellis, MACP
• Elmm Clinic
• Daniel Enselman, LMHC, CDP
• John W Fabianek, D.C.
• Family Care Network PLLC (Island Family Physicians)

• Ophthalmology Physician in Anacortes, WA
• Providers in Anacortes, WA by specialty
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.