Samuel Fred Ellison, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A41459 Issued in CA

Practice address

2001 Union St
Suite 520
San Francisco, CA 94123-4114

Phone

(415) 922-3344

Fax

(415) 921-7759

NPI assigned

Nov 2, 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

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: sellison26825@hisp.ehr.sutterhealth.org

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.

• Csi Medical Group

  • MOHS-Micrographic Surgery Physician
  • San Pedro, CA
  • NPI 1871909804

  Dermatology

  Medicare reassignment NPD
• California Pacific Medical Group, Inc.

  dba Brown & Toland Medical Group

  • Multi-Specialty Clinic/Center
  • Oakland, CA
  • NPI 1275002453
  NPD (past)

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1336228436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 UNION ST",
            "address_2": "SUITE 520",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941234114",
            "telephone_number": "415-922-3344",
            "fax_number": "415-921-7759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 UNION ST",
            "address_2": "SUITE 520",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941234114",
            "telephone_number": "415-922-3344",
            "fax_number": "415-921-7759"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45 Castro St Ste 332",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941141019",
            "country_code": "US",
            "telephone_number": "415-861-2600",
            "fax_number": "415-861-8627",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2555 Ocean Ave Ste 203",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941321645",
            "country_code": "US",
            "telephone_number": "415-921-3322",
            "fax_number": "415-333-8296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "SAMUEL",
        "middle_name": "FRED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A41459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "ZZZ28290Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Shawn Ellis, PSY.D.
• Al Ellison
• Beverly Ellison, MSW, LCSW 75361, CST
• Dematra Ellison
• Dormisha Roxanne Ellison
• Maria Ellman-Horvath
• Kateryna Elloumi
• Sarah Jane Ellsworth
• Elly Laroque M.D., Professional Corporation
• Ernest Elly

• Dermatology Physician in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; 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.