Desta Ellis, M.D.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

400 W Mineral King Ave
Visalia, CA 93291-6237

Phone

(559) 624-6999

NPI assigned

Jun 23, 2014

Last updated

Jun 23, 2014By 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

Medicare fee-for-service enrollment

Enrolled in CA

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.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kaweah Delta Health Care DistrictGroup PAC ID 6608778790, 110 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaweah Health Medical Center Hospital, Visalia, CA, CCN 050057

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Kaweah Delta Health Care District

  dba Kaweah Health Urgent Care

  • Urgent Care Clinic/Center
  • Visalia, CA
  • NPI 1790795458
  Medicare reassignment Care Compare group NPD
• Kaweah Delta Health Care District

  dba Kaweah Health Youth Crisis Stabilization Unit

  • Community/Behavioral Health Agency
  • Visalia, CA
  • NPI 1447016050
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kaweah Delta Health Care District

  dba Kaweah Health Medical Center

  • General Acute Care Hospital
  • Visalia, CA
  • NPI 1588663769
  Care Compare affiliation

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1295140887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W MINERAL KING AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916237",
            "telephone_number": "559-624-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W MINERAL KING AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916237",
            "telephone_number": "559-624-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DESTA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Elizondo
• Ellie J. Zuiderveld (The Children's Dental Surgery Center)
• Elisabeth Elliott, PA-C
• Jennifer K Elliott, DPT
• Betsy Donalyn Ellis
• Rosalie Ellis
• Tyler J. Ellis, MD
• Mary Jean Ellsworth, RN, PHN
• Jennifer Elmer, DDS
• Ata Elmi

• Student in an Organized Health Care Education/Training Program in Visalia, CA
• Providers in Visalia, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.