Individual provider Active NPI

Emiko Ellis, PA-C

  • Physician Assistant
  • Grand Junction, CO
National Provider Identifier
1245992684
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1100 North Ave
Grand Junction, CO 81501-3122
Phone
(970) 248-1020
NPI assigned
Oct 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0008093 CO
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1100 North Ave
Grand Junction, CO 81501-3122

Mailing address

1100 North Ave
Grand Junction, CO 81501-3122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231130000784 CO Practitioner - Physician Assistant 3779931878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley-Wide Health Systems, Inc.Group PAC ID 5991609067, 42 clinicians

Practice addresses (Care Compare)

1012 Belmont Ave
La Junta, CO 81050-2101
Phone (719) 383-5900

1131 Main St
Alamosa, CO 81101-2446
Phone (719) 589-2562

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0008093COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Valley-Wide Health Systems, Inc CurrentSince Oct 19, 2023 Accepting new patients
Valley-Wide Health Systems, Inc. CurrentSince Oct 19, 2023 Accepting new patients
Valley-Wide Health Systems, Inc. Past Accepting new patients

Locations

128 Market St
Alamosa, CO 81101
Phone (719) 587-1001

1131 Main St
Alamosa, CO 81101
Phone (719) 589-2562

1012 Belmont Ave
La Junta, CO 81050
Phone (719) 383-5500

Interoperability endpoints

  • Direct secure messaging: emiko.ellis.p1@direct.vwhs.nextgenshare.com

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1245992684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 NORTH AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815013122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 NORTH AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815013122",
            "telephone_number": "970-248-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "EMIKO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-13",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0008093",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.