Suzanne E Ellison, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

F6604 Issued in TX

Practice address

200 W Windcrest St
Fredericksburg, TX 78624-4408

Phone

(830) 997-0330

Fax

(830) 997-7601

NPI assigned

Sep 26, 2005

Last updated

Mar 22, 2011By 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

• Suzanne Ellison MD PA Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2020 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Suzanne E Ellison MD Professional Association

  • Family Medicine Physician
  • Fredericksburg, TX
  • NPI 1548447923
  Authorized official Same address or phone

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300752000000",
    "number": "1285620211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W WINDCREST ST",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786244408",
            "telephone_number": "830-997-0330",
            "fax_number": "830-997-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W WINDCREST ST",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786244408",
            "telephone_number": "830-997-0330",
            "fax_number": "830-997-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "SUZANNE",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-26",
        "last_updated": "2011-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F6604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "097503903",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8AQ211",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00628708",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZANNE",
            "last_name": "ELLISON MD PA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mark D Eden, MD
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• El Campo Memorial Hospital
• Nick C Engel, PT
• Ericka T McBrine DDS PA
• Carl R. Evans, M.D.
• Emily J Evans, MS, RN, FNP-BC
• Evelyn K Hancock (Brillen Optical)

• Family Medicine Physician in Fredericksburg, TX
• Providers in Fredericksburg, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.