Active NPI
Jacob Ellis, PA-C
- Vascular Surgery Physician
- Colorado Springs, CO
National Provider Identifier
1407730765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 1234
- Practice address
- 7808 Ultra Dr
Colorado Springs, CO 80920-8058 - Phone
- (719) 209-5569
- NPI assigned
- Jul 31, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 1234 | CO | Primary |
Addresses
Primary practice location
7808 Ultra Dr
Colorado Springs, CO 80920-8058
Mailing address
7808 Ultra Dr
Colorado Springs, CO 80920-8058
Phone (719) 209-5569
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1234 | CO | MD | Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753920000000",
"number": "1407730765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7808 ULTRA DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809208058",
"telephone_number": "719-209-5569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7808 ULTRA DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809208058",
"telephone_number": "719-209-5569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JACOB",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-07-31",
"last_updated": "2025-07-31",
"certification_date": "2025-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "CO",
"license": "1234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.