NPIMap

Individual provider Active NPI

Selena W Ellis, MD

  • Neurology Physician
  • Berkeley, CA
National Provider Identifier
1265412993
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A71337 Issued in CA
Practice address
3000 Colby St Ste 302
Berkeley, CA 94705-2058
Phone
(510) 644-2282
Fax
(510) 644-1744
NPI assigned
Jan 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X A71337 CA Primary

Addresses

Primary practice location

3000 Colby St Ste 302
Berkeley, CA 94705-2058

Mailing address

3000 Colby St Ste 302
Berkeley, CA 94705-2058
Phone (510) 644-2282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040524001296 CA Practitioner - Neurology 1456342724 Receives reassigned benefits from 1 practitioner
Practice locations: Berkeley, CA
I20251229001781 NY Practitioner - Neurology 1456342724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Meeting House Lane Medical Practice PCGroup PAC ID 6800972589, 125 clinicians

Practice addresses (Care Compare)

325 Meeting House LN
Southampton, NY 11968-5087
Phone (631) 283-4048

4 Springville Rd
Suite B
Hampton Bays, NY 11946-2208

4 Springville Rd B
Hampton Bays, NY 11946-2290

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • Alta Bates Summit Medical Center - Alta Bates Camp Hospital, Berkeley, CA, CCN 050305

Merit-based Incentive Payment System (MIPS)

Final score
91.81 of 100Reported as individual
Quality
80.38
Promoting interoperability
92
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A71337CAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Meeting House Lane Medical Practice PC CurrentSince Jan 1, 2026 Accepting new patients
Selena Ellis, M.D. Neurology CurrentSince Apr 15, 2005 Accepting new patients
Summit Medical Group PA Past Accepting new patients
California Pacific Medical Group, Inc. Past Accepting new patients
Hospitalists Emo, LLC Past Accepting new patients
Sutter East Bay Medical Foundation Neurology PastSince Oct 1, 2023 Accepting new patients

Locations

3000 Colby St
Ste 101
Berkeley, CA 94705
Phone (510) 644-2282

182 W Montauk Hwy
Ste C
Hampton Bays, NY 11946
Phone (631) 353-7810

325 Meeting House Ln
Ste 301
Southampton, NY 11968
Phone (631) 283-4048

325 Meeting House Ln
Ste 403
Southampton, NY 11968
Phone (631) 283-2100

147 Beach Rd
Ste D
Westhampton Beach, NY 11978
Phone (631) 283-0918

Interoperability endpoints

  • Direct secure messaging: sellis160228@hisp.ehr.sutterhealth.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/CEGCBA

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 6

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 7

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": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1265412993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 COLBY ST STE 302",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052058",
            "telephone_number": "510-644-2282",
            "fax_number": "510-644-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 COLBY ST STE 302",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052058",
            "telephone_number": "510-644-2282",
            "fax_number": "510-644-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SELENA",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-19",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A71337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.