Mary Ann Ellis-Jammal, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A37659 Issued in CA

Practice address

151 N. Sunrise Ave Suite 1403
Roseville, CA 95661

Phone

(916) 771-4414

Fax

(916) 771-4411

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mellisjammal80765@hisp.ehr.sutterhealth.org

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.

• Sutter North Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1144251521
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1245341817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N. SUNRISE AVE SUITE 1403",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95661",
            "telephone_number": "916-771-4414",
            "fax_number": "916-771-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N. SUNRISE AVE SUITE 1403",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95661",
            "telephone_number": "916-771-4414",
            "fax_number": "916-771-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS-JAMMAL",
        "first_name": "MARY ANN",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A37659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A376590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elite Medical Technologies, LLC
• Diana Denise Ellering, CMT
• Charles Elliot, PHARMD
• Alexandra Rose Maureen Elliott
• Sarah D Elliott, PSYD
• Amy Elizabeth Ellis, MD
• Amy Roskelley Ellis, M.S.
• Lorraine A. Ellis, MFT
• Madeline Ellis
• Boris D. Ellyason, MD

• Pediatrics Physician in Roseville, CA
• Providers in Roseville, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.