Kevin Ellis, D.O

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A5449 Issued in CA

Practice address

855 E Madison Ave
El Cajon, CA 92020-3819

Phone

(619) 440-2751

Fax

(619) 440-2945

NPI assigned

Jul 13, 2006

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• North County Health Project Inc

  • Federally Qualified Health Center (FQHC)
  • San Marcos, CA
  • NPI 1588489975
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306861703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N DATE ST",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253413",
            "telephone_number": "760-737-2035",
            "fax_number": "760-741-2782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 E MADISON AVE",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920203819",
            "telephone_number": "619-440-2751",
            "fax_number": "619-440-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KEVIN",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A5449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nour Moataz Elgezawi, ACSW
• Fadi Elia
• Zeyad Elia
• Yana Eliseev
• Olivia Ellegaard
• Robert Brian Ellison
• Judy Elms
• Jacob Elser
• Embrace Medical Equipment
• Kathleen Kelly Barbosa Emidy

• Family Medicine Physician in El Cajon, CA
• Providers in El Cajon, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.