NPIMap

Individual provider Active NPI

George Ellis Jr., M.D.

  • Internal Medicine Physician
  • Boardman, OH
National Provider Identifier
1366428484
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35060641E Issued in OH
Practice address
910 Boardman-Canfield Road
Boardman, OH 44512
Phone
(330) 965-0832
Fax
(330) 965-0155
NPI assigned
Dec 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35060641 OH
Internal Medicine Physician 207R00000X 35060641E OH Primary

Addresses

Primary practice location

910 Boardman-Canfield Road
Boardman, OH 44512

Mailing address

910 Boardman-Canfield Road
Boardman, OH 44512
Phone (330) 965-0832

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address george.ellis.jr@salemregional.medicity.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20041217000265 OH Practitioner - Internal MedicinePractitioner - Emergency Medicine 7214994524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SCH Professional CorporationGroup PAC ID 0941291868, 59 clinicians

Practice addresses (Care Compare)

750 E Park Ave
Columbiana, OH 44408-1448
Phone (330) 892-0442

910 Boardman Canfield Rd
Youngstown, OH 44512-4218

Hospital & facility affiliations

  • Patriot Homecare, Inc Home health agency, Girard, OH, CCN 368406
  • Salem Regional Medical Center Hospital, Salem, OH, CCN 360185
  • MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064
  • HMHP St Elizabeth Boardman Health Center Hospital, Boardman, OH, CCN 360276
  • Surgical Hospital at Southwoods Hospital, Youngstown, OH, CCN 360352

Merit-based Incentive Payment System (MIPS)

Final score
84.84 of 100Reported as apm
Quality
69.69
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35060641OHMDEmergency Medicine Physician
35060641EOHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gateways to Better Living, Inc. Past Accepting new patients
Gateways to Better Living, Inc. Past Accepting new patients
Mahoning Valley Emergency Specialists LLC Emergency Medicine Past Accepting new patients
Gateways to Better Living, Inc. Past Accepting new patients

Organizations & group practices 5

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 7

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": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1366428484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 BOARDMAN-CANFIELD ROAD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "44512",
            "telephone_number": "330-965-0832",
            "fax_number": "330-965-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 BOARDMAN-CANFIELD ROAD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "44512",
            "telephone_number": "330-965-0832",
            "fax_number": "330-965-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "GEORGE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35060641",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35060641E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "george.ellis.jr@salemregional.medicity.net",
            "affiliation": "N",
            "address_1": "910 BOARDMAN-CANFIELD ROAD",
            "city": "BOARDMAN",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.