Active NPI
Stephen C. Ellis, MD
- Anesthesiology Physician
- Independence, MO
National Provider Identifier
1275515314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- R5J54
- Practice address
- 19600 E 39TH St S
Independence, MO 64057-2301 - Phone
- (913) 428-2900
- Fax
- (913) 428-2951
- NPI assigned
- Nov 15, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | R5J54 | MO | Primary |
| Anesthesiology Physician | 207L00000X | 04-21076 | KS |
Addresses
Primary practice location
19600 E 39TH St S
Independence, MO 64057-2301
Mailing address
8717 W 110TH St
Suite 600
Overland Park, KS 66210-2144
Phone (913) 428-2900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100192350C | Medicaid | KS | |
| 202168845 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-21076 | KS | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KC Pain Centers, LLC | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408320000000",
"number": "1275515314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8717 W 110TH ST",
"address_2": "SUITE 600",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662102144",
"telephone_number": "913-428-2900",
"fax_number": "913-428-2951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19600 E 39TH ST S",
"city": "INDEPENDENCE",
"state": "MO",
"postal_code": "640572301",
"telephone_number": "913-428-2900",
"fax_number": "913-428-2951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "STEPHEN",
"middle_name": "C.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-15",
"last_updated": "2014-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MO",
"license": "R5J54",
"primary": true
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "KS",
"license": "04-21076",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100192350C",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202168845",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Independence, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.