Active NPI
Keith Errett Ellis, M.D.
- Family Medicine Physician
- Savannah, GA
National Provider Identifier
1356490775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 26106
- Practice address
- 1107 E 66TH St
Savannah, GA 31404-5701 - Phone
- (912) 350-8404
- Fax
- (912) 350-8067
- NPI assigned
- Jan 9, 2007
- Last updated
- Mar 3, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 26106 | GA | Primary |
Addresses
Primary practice location
1107 E 66TH St
Savannah, GA 31404-5701
Mailing address
1107 E 66TH St
Savannah, GA 31404-5701
Phone (912) 350-8404
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CH5121 | Other | GA | RR MEDICARE GROUP ID |
| G26106 | Medicaid | SC | |
| GRP3905 | Other | GA | GA MEDICARE GROUP ID |
| 000526578B | Medicaid | GA | |
| 080164682 | Other | GA | RR MEDICARE |
| 582162071-014 | Other | HMHS/TRICARE SOUTH | |
| 000526578C | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26106 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393804800000",
"number": "1356490775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1107 E 66TH ST",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314045701",
"telephone_number": "912-350-8404",
"fax_number": "912-350-8067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1107 E 66TH ST",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314045701",
"telephone_number": "912-350-8404",
"fax_number": "912-350-8067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "KEITH",
"middle_name": "ERRETT",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2014-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "26106",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP ID",
"identifier": "CH5121",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G26106",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA MEDICARE GROUP ID",
"identifier": "GRP3905",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000526578B",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "080164682",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMHS/TRICARE SOUTH",
"identifier": "582162071-014",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000526578C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.