John Ellie Jr., D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

006649 Issued in NY

Practice address

1500 Portland Ave
Podiatry Suite
Rochester, NY 14621-3065

Phone

(585) 642-6100

Fax

(585) 642-6111

NPI assigned

Jun 25, 2012

Last updated

Mar 17, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

New York College of Podiatric Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rochester General Hospital Hospital, Rochester, NY, CCN 330125

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Podiatry Affiliate of Rochester PLLC

  • Foot & Ankle Surgery Podiatrist
  • Rochester, NY
  • NPI 1710490263

  Single Specialty

  Medicare reassignment NPD Authorized official
• Wound Care Medical Associates PC

  • Specialist
  • Rochester, NY
  • NPI 1770003857

  Single Specialty

  Medicare reassignment NPD
• St. John's Penfield Homes Corporation

  • Skilled Nursing Facility
  • Fairport, NY
  • NPI 1770867988

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1427311455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 PORTLAND AVE",
            "address_2": "PODIATRY/MED OFFICE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14621",
            "telephone_number": "585-642-6100",
            "fax_number": "585-642-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 PORTLAND AVE",
            "address_2": "PODIATRY SUITE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213065",
            "telephone_number": "585-642-6100",
            "fax_number": "585-642-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIE",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NY",
            "license": "006649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05448155",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04203352",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bridgette Ellenwood, LPN
• Eileen Marie Eller, M.S., CCC-SLP
• Sandra Jane Eller, PH.D.
• Charles Rober Ellermeyer, OD
• Emilie Ellicott, DO
• Ronald Francis Ellingham Jr., RN
• Shuntay Ellington, LPN
• Barbara Elliott, R.N.
• Cecelia Ann Elliott
• Chelsea Elliott, MS OTR/L

• Foot & Ankle Surgery Podiatrist in Rochester, NY
• Providers in Rochester, NY by specialty
• Foot & Ankle Surgery Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; 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.