Henry Dudley Ellington III, P.A.C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5574 Issued in AZ

Practice address

1701 E Thomas Rd
Suite a-104
Phoenix, AZ 85016-7646

Phone

(888) 381-4858

NPI assigned

Dec 6, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Waianae District Comprehensive Health and Hospital Board, Inc

  • Family Medicine Physician
  • Waianae, HI
  • NPI 1275566424
  Medicare reassignment NPD (past)
• Waianae District Comprehensive Health and Hospital Board, Inc

  • Federally Qualified Health Center (FQHC)
  • Waianae, HI
  • NPI 1851764179
  NPD
• Waianae District Comprehensive Health and Hospital Board, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Waianae, HI
  • NPI 1710709365
  NPD
• Nextcare Arizona I JV LLC

  • Urgent Care Clinic/Center
  • Tempe, AZ
  • NPI 1114798071
  NPD (past)

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1316921992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 E THOMAS RD",
            "address_2": "SUITE A-104",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167646",
            "telephone_number": "888-381-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E THOMAS RD",
            "address_2": "SUITE A-104",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167646",
            "telephone_number": "888-381-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGTON",
        "first_name": "HENRY",
        "middle_name": "DUDLEY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5574",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "HI",
            "license": "AMD-132",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Ellert, MD
• Traci Ellery, MS, ATC
• Lori Ellezian
• Sunanda Ellina, MD
• Mitchell Ward Ellingson, D.D.S.
• Patricia Elliot, OTR/L
• Michelle Loy Elliott Smell
• Stacie Elliott-Donison
• Audrey Corsberg Elliott, PMHNP
• Beth Ann Elliott, LCSW

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.