Ethan R Ellis, M.D.

Primary specialty

Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X

License

DR.0053902 Issued in CO

Practice address

2121 E Harmony Rd
Ste 100
Fort Collins, CO 80528-3400

Phone

(970) 221-1000

NPI assigned

Apr 11, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE, CO, WY3 enrollments

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 3

Specialty

Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)

Education

University of Rochester School of Medicine and Dentistry, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Poudre Valley Medical Group LLCGroup PAC ID 9638208549, shared by 2 NPIs, 2,425 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119
• Regional West Medical Center Hospital, Scottsbluff, NE, CCN 280061
• Poudre Valley Hospital Hospital, Fort Collins, CO, CCN 060010
• Uchealth Greeley Hospital Hospital, Greeley, CO, CCN 060131
• Longs Peak Hospital Hospital, Longmont, CO, CCN 060128

Procedures performed for Medicare patients

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 and National Provider Directory roles.

• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868
  Medicare reassignment NPD
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260

  NE, WY

  Medicare reassignment NPD

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

• Longs Peak Hospital

  • General Acute Care Hospital
  • Longmont, CO
  • NPI 1154876985
  Care Compare affiliation
• Medical Center of the Rockies

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1104262286
  Care Compare affiliation
• Medical Center of the Rockies

  • General Acute Care Hospital
  • Loveland, CO
  • NPI 1750392304
  Care Compare affiliation
• Medical Center of the Rockies

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1780243055
  Care Compare affiliation
• Poudre Valley Health Care Inc

  • Clinic/Center
  • Fort Collins, CO
  • NPI 1457494304

  Hospital

  Care Compare affiliation
• Poudre Valley Health Care Inc

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1679419808
  Care Compare affiliation
• Poudre Valley Health Care Inc

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1962158857
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1073172094
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1093374001
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1093374092
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1114586278
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1184283103
  Care Compare affiliation

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459123200000",
    "number": "1316110208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-221-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-221-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ETHAN",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-11",
        "last_updated": "2016-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "CO",
            "license": "DR.0053902",
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NE",
            "license": "27958",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "235720",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CO",
            "license": "DR.0053902",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0053902",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "87529351",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Jo Elliott, RDH
• Lida Anne Elliott, LPC
• Amanda J Ellis Turpin
• Cherlyn Ellis, OTR/L
• Christine Ellis, RPH
• Jordan Marie Ellis
• Monica Therese Ellis, MS, CCC-SLP
• Kaitlin Elise Elmore, MDIV.
• Kristine Amy Elmore, SLP
• Richard Christopher Elmore, C.R.N.A.

• Clinical Cardiac Electrophysiology Physician in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Clinical Cardiac Electrophysiology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; 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.