Evan D Ellis, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

MD60270460 Issued in WA

Practice address

200 NE Mother Joseph PL
Suite 210
Vancouver, WA 98664-3299

Phone

(360) 254-6161

Fax

(360) 449-1139

NPI assigned

Aug 25, 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 1

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Orthopedic SurgeryAlso: Sports Medicine

Education

University of Michigan Medical School, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northwest Surgical Specialists PCGroup PAC ID 4183527153, 118 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150
• Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050
• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
• Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038
• Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: evan.ellis.p1@direct.reboundmd.nextgenshare.com
• Direct secure messaging: eellis21822@reboundmd.gardenplot.direct-ci.com

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.

• Northwest Surgical Specialists, P.C.

  • Orthopaedic Surgery Physician
  • Portland, OR
  • NPI 1730118803

  WA

  Medicare reassignment Care Compare group NPD
• Northwest Surgical Specialists PC

  • Durable Medical Equipment & Medical Supplies
  • Vancouver, WA
  • NPI 1821510306
  NPD
• J and D Physical Therapy Services

  • Physical Therapy Clinic/Center
  • Portland, OR
  • NPI 1134299951
  NPD (past)

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

• Legacy Salmon Creek Hospital

  • Clinic/Center
  • Vancouver, WA
  • NPI 1356357784

  Hospital

  Care Compare affiliation
• Legacy Salmon Creek Hospital

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1700809829
  Care Compare affiliation
• Peacehealth

  • Cardiovascular Disease Physician
  • Vancouver, WA
  • NPI 1003194911

  Hospital

  Care Compare affiliation
• Peacehealth

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1134178999
  Care Compare affiliation
• Legacy Meridian Park Hospital

  • General Acute Care Hospital
  • Tualatin, OR
  • NPI 1184647620
  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Clinic/Center
  • Portland, OR
  • NPI 1326272741

  Hospital

  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Oregon City, OR
  • NPI 1912282369
  Care Compare affiliation

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347840000000",
    "number": "1366559163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL",
            "address_2": "SUITE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643299",
            "telephone_number": "360-254-6161",
            "fax_number": "360-449-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL",
            "address_2": "SUITE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643299",
            "telephone_number": "360-254-6161",
            "fax_number": "360-449-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "EVAN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2012-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD60270460",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WA",
            "license": "MD60270460",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366559163",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Mae Elliott, PA-C
• Elizabeth Ballard Elliott, NP
• Ellis Burke Jardine, DMD, PC
• Autumn M Ellis, CDP
• Cara Davidson Ellis, MD
• Keri J Ellis, LPN
• Madeline Ellis
• Madelynn Ellis, OD
• Meagan Ellis
• Nasina Ellis

• Orthopaedic Surgery Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Orthopaedic Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.