Active NPI
James Stephen Ellis, PH.D.
- Psychologist
- McComb, MS
National Provider Identifier
1437183308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 30428
- Practice address
- 1701 White St
McComb, MS 39648-2711 - Phone
- (601) 684-2173
- Fax
- (601) 249-4234
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 30428 | MS | Primary |
Addresses
Primary practice location
1701 White St
McComb, MS 39648-2711
Mailing address
1701 White St
McComb, MS 39648-2711
Phone (601) 684-2173
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0124731 | Medicaid | MS |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30428 | MS | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SW Ms Mental Health Mental Retardation Commission | Past | Accepting new patients | |
| Southwest Mississippi Mental Health Mental Retardation Commission | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Social Worker
- McComb, MS
- NPI 1366694820
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- McComb, MS
- NPI 1184662694
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437183308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 WHITE ST",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396482711",
"telephone_number": "601-684-2173",
"fax_number": "601-249-4234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 WHITE ST",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396482711",
"telephone_number": "601-684-2173",
"fax_number": "601-249-4234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JAMES",
"middle_name": "STEPHEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MS",
"license": "30428",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0124731",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in McComb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.