Individual provider Active NPI

Jeffrey Cowan Ellison, MD

  • Gastroenterology Physician
  • Fayetteville, AR
National Provider Identifier
1407040488
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
E-6356 Issued in AR
Practice address
3344 N Futrall Dr
Fayetteville, AR 72703-4057
Phone
(479) 521-8200
Fax
(479) 582-7310
NPI assigned
Sep 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X E-6356 AR Primary
Internal Medicine Physician 207R00000X 25527 AR

Addresses

Primary practice location

3344 N Futrall Dr
Fayetteville, AR 72703-4057

Mailing address

PO Box 1523
Fayetteville, AR 72702-1523
Phone (479) 571-6038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20100729000964 AR Practitioner - GastroenterologyPractitioner - Internal Medicine 2264565035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Arkansas College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Digestive Disease Consultants, PLLCGroup PAC ID 3375531379, 616 clinicians

Practice addresses (Care Compare)

3901 Pkwy Cir
Suite 550
Springdale, AR 72762-6362
Phone (479) 346-1850

Hospital & facility affiliations

  • Northwest Medical Center-Springdale Hospital, Springdale, AR, CCN 040022
  • Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004

Merit-based Incentive Payment System (MIPS)

Final score
80.98 of 100Reported as group
Quality
66.51
Promoting interoperability
98
Improvement activities
40
Cost
71.76

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy122
Upper gastrointestinal (GI) endoscopy for acid reflux91

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25527ARMDInternal Medicine Physician

Organizations & group practices 1

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 2

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": "1188604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1407040488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1523",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021523",
            "telephone_number": "479-571-6038",
            "fax_number": "479-582-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3344 N FUTRALL DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034057",
            "telephone_number": "479-521-8200",
            "fax_number": "479-582-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "JEFFREY",
        "middle_name": "COWAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-01",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "E-6356",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "25527",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.