Richard K Ellis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

21182 Issued in SC

Practice address

148 Sauls St
Lake City, SC 29560-2631

Phone

(843) 374-3621

Fax

(843) 374-3624

NPI assigned

Sep 16, 2006

Last updated

Dec 4, 2013By 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 SC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Carolina Family Care, Inc

  dba MUSC Physicians PCP

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1184655722
  Medicare reassignment NPD
• Carolina Family Care, Inc

  dba MUSC Physicians PC

  • Family Medicine Physician
  • Florence, SC
  • NPI 1093076457
  NPD
• Doctors Care, PA

  • Family Medicine Physician
  • Columbia, SC
  • NPI 1366499048
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386115200000",
    "number": "1245336932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 118008",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294238008",
            "telephone_number": "843-374-3621",
            "fax_number": "843-374-3624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 SAULS ST",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602631",
            "telephone_number": "843-374-3621",
            "fax_number": "843-374-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "RICHARD",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2013-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "21182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211826",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR PTAN",
            "identifier": "P01055600",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Renee Dicks, B.A.
• Shafara Dozier, PA-C
• Kelly Eaddy, RN
• East Main Medical Services, LLC
• East Main Medical Services, LLC
• Elm Pediatrics, LLC
• Elm Pediatrics, LLC
• Teresa English
• Kevin D Epps
• Eyewear Boutique Inc

• Family Medicine Physician in Lake City, SC
• Providers in Lake City, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; 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.