Active NPI
Jason Ted Ellis, RPH
- Pharmacist
- Spencer, IA
National Provider Identifier
1285197673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18437
- Practice address
- 500 11TH St SW
Spencer, IA 51301-5826 - Phone
- (712) 262-5011
- Fax
- (712) 262-5469
- NPI assigned
- Apr 11, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 18437 | IA | Primary |
Addresses
Primary practice location
500 11TH St SW
Spencer, IA 51301-5826
Mailing address
1503 W 13TH St
Spencer, IA 51301-2925
Phone (712) 260-6120
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)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18437 | IA | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554940800000",
"number": "1285197673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1503 W 13TH ST",
"city": "SPENCER",
"state": "IA",
"postal_code": "513012925",
"telephone_number": "712-260-6120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 11TH ST SW",
"city": "SPENCER",
"state": "IA",
"postal_code": "513015826",
"telephone_number": "712-262-5011",
"fax_number": "712-262-5469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JASON",
"middle_name": "TED",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-11",
"last_updated": "2019-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "18437",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spencer, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.