Vicki Ellis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD431001 Issued in PA

Practice address

11116 Medical Campus Rd
Hagerstown, MD 21742-6710

Phone

(240) 313-9580

NPI assigned

Feb 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vellis411810@wellspan.direct-ci.com
• Direct secure messaging: vickiellis@direct-address.org

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.

• Fulton County Medical Center

  • Critical Access Hospital
  • MC Connellsburg, PA
  • NPI 1326044694

  Family Medicine

  Medicare reassignment NPD
• Keystone Rural Health Center

  • Federally Qualified Health Center (FQHC)
  • Chambersburg, PA
  • NPI 1538166905
  Medicare reassignment NPD
• Fulton County Medical Center

  • Critical Access Hospital
  • MC Connellsburg, PA
  • NPI 1386722312
  NPD
• Keystone Rural Health Center

  • Community/Retail Pharmacy
  • Chambersburg, PA
  • NPI 1053105288
  NPD
• Keystone Rural Health Center

  • Federally Qualified Health Center (FQHC)
  • Chambersburg, PA
  • NPI 1639462427
  NPD
• Washington County Emergency Medicine Physicians, LLC

  • Emergency Care Clinic/Center
  • Hagerstown, MD
  • NPI 1205826724
  NPD (past)
• Fulton County Medical Center

  • Skilled Nursing Facility
  • MC Connellsburg, PA
  • NPI 1174518518
  NPD (past)
• Hartsville Hma Physician Management Inc

  • Family Medicine Physician
  • Hartsville, SC
  • NPI 1821021817
  NPD (past)
• KB Management Services LLC

  • Emergency Medicine Physician
  • Hartsville, SC
  • NPI 1053459818
  NPD (past)
• QHG of South Carolina Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Mullins, SC
  • NPI 1932464708
  NPD (past)

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1407828486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11116 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11116 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426710",
            "telephone_number": "240-313-9580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Chambers Hill Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Chambersburg",
            "state": "PA",
            "postal_code": "172017304",
            "country_code": "US",
            "telephone_number": "717-709-7979",
            "fax_number": "717-709-7980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "VICKI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-03",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D65453",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD431001",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "19454",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "451601000",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101931175",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "304010100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00442458",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby Hope Elliott, LCPC
• Amber Ellis, CNA, GNA
• Brandon Keith Ellis, DDS
• Mark J Ellis
• Megan Danielle Ellis, LPN
• Kezia Lynnette Ellison, MD
• Nia Imani Elmore
• Anna K. Elwood, PMH NP-BC
• Emeritol Lo Hagerstown
• Emeritus Corporation

• Family Medicine Physician in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.