Diana Hwei-Ann Jan Ellis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DJ018840 Issued in MI

Practice address

500 N Jackson St
Jackson, MI 49201-1223

Phone

(517) 748-5500

Fax

(517) 780-9286

NPI assigned

Oct 2, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

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 3

Other names 1

• Dr. Diana Hwei-Ann Jan-Ellis Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dellis451089@direct.hfhs.org

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.

• Center for Family Health

  • Federally Qualified Health Center (FQHC)
  • Jackson, MI
  • NPI 1780784439

  General Practice

  Medicare reassignment NPD
• Center for Family Health

  • Federally Qualified Health Center (FQHC)
  • Jackson, MI
  • NPI 1588722300
  NPD
• Center for Family Health

  • Federally Qualified Health Center (FQHC)
  • Jackson, MI
  • NPI 1710764410
  NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1255424214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N JACKSON ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011266",
            "telephone_number": "517-748-5500",
            "fax_number": "517-780-9286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N JACKSON ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011223",
            "telephone_number": "517-748-5500",
            "fax_number": "517-780-9286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DIANA",
        "middle_name": "HWEI-ANN JAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "DJ018840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "D801057",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "744718389",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL PROVIDER NUM",
            "identifier": "88131",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "JAN-ELLIS",
            "middle_name": "HWEI-ANN",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karim Elghawy, M.D.
• Elite Care, LLC
• Elizabeth J. Rutledge, DDS, PLC (Springcrest Dental Associates)
• Kiana Elliott
• Tiffany Elliott, LLMSW
• Jolene Ellis, M.D.
• Shawn Archie Ellis, NP
• Kylie Ellsworth
• Ayman Elmadawy, DDS
• Elmortada Medical Services PC

• General Practice Dentistry in Jackson, MI
• Providers in Jackson, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.