Active NPI
Jessica Laine Ellis, M.D.
- Sports Medicine (Family Medicine) Physician
- Springfield, OR
National Provider Identifier
1245270222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- MD172850
- Practice address
- 1435 G St
Springfield, OR 97477-4113 - Phone
- (541) 242-4812
- Fax
- (541) 242-4813
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | MD172850 | OR | Primary |
Addresses
Primary practice location
1435 G St
Springfield, OR 97477-4113
Mailing address
PO Box 1648
Eugene, OR 97440-1648
Phone (541) 242-4812
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500694329 | Medicaid | OR |
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 |
|---|---|---|---|
| Ora Orthopedics PC | Sports Medicine | Past | Accepting new patients |
| Ora Orthopedics, PC | Past | Accepting new patients | |
| Genesis Medical Education Foundation Inc | Past | Accepting new patients |
Interoperability endpoints
- jellis38@yourcarecommunity.org
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 and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449187200000",
"number": "1245270222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1648",
"city": "EUGENE",
"state": "OR",
"postal_code": "974401648",
"telephone_number": "541-242-4812",
"fax_number": "541-284-2038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1435 G ST",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974774113",
"telephone_number": "541-242-4812",
"fax_number": "541-242-4813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JESSICA",
"middle_name": "LAINE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-07",
"last_updated": "2015-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "OR",
"license": "MD172850",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500694329",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.