Ellis A Ingram, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

R6258 Issued in MO

Practice address

One Hospital Dr
Columbia, MO 65212-0001

Phone

(573) 882-1319

Fax

(573) 884-4612

NPI assigned

Jun 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203465600000",
    "number": "1366489080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7687",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652057687",
            "telephone_number": "573-882-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE HOSPITAL DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652120001",
            "telephone_number": "573-882-1319",
            "fax_number": "573-884-4612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "ELLIS",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2008-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MO",
            "license": "R6258",
            "primary": true
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "MO",
            "license": "R6258",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALHCARE",
            "identifier": "1104034",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "126604",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD/BLUE CROSS",
            "identifier": "127403",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Independent Living Concepts, LLC
• Individual Marriage and Family Enrichment LLC
• Derek Ingalls, PLPC
• Kevin Lucas Ingalls, MD
• Angela Dawn Ingram, MD
• Lakreisha Ingram
• Lindsay K Ingram, LPC
• Cythia Sue Inlow, LCSW
• Regina Ann Inman, PHARM.D.
• Innate Health and Wellness

• Anatomic Pathology & Clinical Pathology Physician in Columbia, MO
• Providers in Columbia, MO by specialty
• Anatomic Pathology & Clinical Pathology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.