NPIMap

Individual provider Active NPI

Edward D Ellison, M.D.

  • Urology Physician
  • Coeur D' Alene, ID
National Provider Identifier
1346375235
Registry record updated May 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
M-8020 Issued in ID
Practice address
980 Ironwood Dr W
Ste 104
Coeur D' Alene, ID 83814
Phone
(208) 667-0621
Fax
(208) 664-1709
NPI assigned
Feb 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X M-8020 ID Primary

Addresses

Primary practice location

980 Ironwood Dr W
Ste 104
Coeur D' Alene, ID 83814

Mailing address

980 Ironwood Dr W
Ste 104
Coeur D' Alene, ID 83814
Phone (208) 667-0621

Other identifiers 1

IdentifierTypeStateIssuer
805898101MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090314000004 ID Practitioner - Urology 1052412707 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Oregon Health Sciences University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Idaho Urology PLLCGroup PAC ID 1456452291, 9 clinicians

Practice addresses (Care Compare)

980 W Ironwood Dr
Suite 104
Coeur D Alene, ID 83814-2668
Phone (208) 667-0621

Hospital & facility affiliations

  • Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049
  • Benewah Community Hospital Hospital, Saint Maries, ID, CCN 131317
  • Bonner General Hospital Hospital, Sandpoint, ID, CCN 131328
  • Boundary Community Hospital Hospital, Bonners Ferry, ID, CCN 131301
  • Shoshone Medical Center Hospital, Kellogg, ID, CCN 131314

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as apm
Quality
89.26
Promoting interoperability
69.9
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Kootenai Health, Inc. CurrentSince Oct 9, 2020 Accepting new patients
North Idaho Urology, PLLC Urology CurrentSince Jan 1, 2002 Accepting new patients
Kootenai Health, Inc. Urology CurrentSince Jan 1, 2002 Accepting new patients
Kootenai Health, Inc. CurrentSince Oct 9, 2020 Accepting new patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

2177 W Ironwood Center Dr
Coeur D Alene, ID 83814
Phone (208) 625-6111

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

980 W Ironwood Dr
Ste 104
Coeur D Alene, ID 83814
Phone (208) 667-0621

1300 E Mullan Ave
Ste 700
Post Falls, ID 83854
Phone (208) 625-5564

420 N Second Ave
Sandpoint, ID 83864
Phone (208) 263-2173

Interoperability endpoints

  • Direct secure messaging: eellison631032@direct.multicare.org

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337904000000",
    "number": "1346375235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 IRONWOOD DR W",
            "address_2": "STE 104",
            "city": "COEUR D' ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-667-0621",
            "fax_number": "208-664-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 IRONWOOD DR W",
            "address_2": "STE 104",
            "city": "COEUR D' ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-667-0621",
            "fax_number": "208-664-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "EDWARD",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2012-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ID",
            "license": "M-8020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805898101",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D' Alene, ID

Sources for this page

Verify at the official NPI Registry.