Mark Dalton Ellis, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-32484 Issued in ID

Practice address

1418 Fillmore St
Twin Falls, ID 83301-3380

Phone

(208) 735-2237

NPI assigned

Jun 12, 2012

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

Enrolled in ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Crosspointe Mental Health, LLC

  • Primary Care Clinic/Center
  • Twin Falls, ID
  • NPI 1386914505
  Medicare reassignment
• LDS Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Twin Falls, ID
  • NPI 1013122563
  NPD (past)

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386115200000",
    "number": "1336401710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 FILLMORE ST",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013380",
            "telephone_number": "208-735-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 FILLMORE ST",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013380",
            "telephone_number": "208-735-2237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARK",
        "middle_name": "DALTON",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-12",
        "last_updated": "2013-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-32484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Ann Eldredge, ATC
• Elite Medicine PC
• Inga L Elkin, M.ED, LCPC
• Carisa Dawn Elliott, FNP-C
• Julie A Ellis, PT
• Corwin Ryan Ellsworth, PA-C
• Brandy Gail Emdin
• Valerie Jeannine Emery, BEHAVIORAL TECH
• Bret Paul Empey, PT, DPT
• Timothy Adam Enders, D.O.

• Clinical Social Worker in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.