Individual provider Active NPI

Daniel Ellis, PA-C

  • Physician Assistant
  • Ozark, MO
National Provider Identifier
1366077240
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2020008438 Issued in MO
Practice address
3050 E River Bluff Blvd
Ozark, MO 65721-8807
Phone
(417) 820-5610
NPI assigned
Mar 11, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2020008438 MO Primary

Addresses

Primary practice location

3050 E River Bluff Blvd
Ozark, MO 65721-8807

Mailing address

3050 E River Bluff Blvd
Ozark, MO 65721-8807
Phone (417) 820-5610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20200327001032 MO Practitioner - Physician Assistant 1456780345 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203

1605 Martin Springs Dr
Rolla, MO 65401-2980

2115 S Fremont Ave
Springfield, MO 65804-2232

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

3050 E River Bluff Blvd
MC Orthopedics
Ozark, MO 65721-8807
Phone (417) 820-5610

Hospital & facility affiliations

  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065
  • Mercy Hospital Lebanon Hospital, Lebanon, MO, CCN 260059

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Apr 13, 2020 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 13, 2020 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 13, 2020 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

331 Hospital Dr
Ste A
Lebanon, MO 65536
Phone (417) 532-8856

3050 E River Bluff Blvd
Ozark, MO 65721
Phone (417) 820-5610

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

2115 S Fremont Ave
Ste 4300
Springfield, MO 65804
Phone (417) 829-3911

620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215

Interoperability endpoints

  • Direct secure messaging: dellis1051265@directc.mercy.net

Organizations & group practices 4

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 11

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": "1583884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1366077240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 E RIVER BLUFF BLVD",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657218807",
            "telephone_number": "417-820-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 E RIVER BLUFF BLVD",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657218807",
            "telephone_number": "417-820-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2020008438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozark, MO

Sources for this page

Verify at the official NPI Registry.