NPIMap

Individual provider Active NPI

Mariana Alyn Ellington, MD

  • Obstetrics & Gynecology Physician
  • Statesville, NC
National Provider Identifier
1447712005
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
2023-01553 Issued in NC
Practice address
1446 Fern Creek Dr
Statesville, NC 28625-9376
Phone
(704) 873-9617
Fax
(704) 761-6985
NPI assigned
Apr 3, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Obstetrics & Gynecology Physician 207V00000X 2023-01553 NC Primary
Obstetrics & Gynecology Physician 207V00000X 11257 GA

Addresses

Primary practice location

1446 Fern Creek Dr
Statesville, NC 28625-9376

Mailing address

PO Box 1845
Statesville, NC 28687-1845
Phone (704) 873-4277

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230801004074 NC Practitioner - Obstetrics/Gynecology 7113254301 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Healthcare PAGroup PAC ID 9638070683, 226 clinicians

Practice addresses (Care Compare)

1446 Fern Creek Dr
Statesville, NC 28625-9376
Phone (704) 873-9617

Hospital & facility affiliations

  • Iredell Memorial Hospital Inc Hospital, Statesville, NC, CCN 340039

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11257GAMDObstetrics & Gynecology Physician
2023-01553NCMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Healthcare, PA CurrentSince Sep 1, 2023 Accepting new patients
Piedmont Healthcare, P.a. Obstetrics & Gynecology CurrentSince Sep 1, 2023 Accepting new patients

Locations

650 Signal Hill Drive Ext
Statesville, NC 28625
Phone (704) 873-4277

1446 Fern Creek Dr
Statesville, NC 28625
Phone (704) 873-9617

208 Old Mocksville Rd
Statesville, NC 28625
Phone (704) 838-8215

Interoperability endpoints

  • Direct secure messaging: marianaellington@phc.allscriptsdirect.net

Organizations & group practices 9

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 1

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": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1447712005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1845",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286871845",
            "telephone_number": "704-873-4277",
            "fax_number": "704-978-3549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1446 FERN CREEK DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286259376",
            "telephone_number": "704-873-9617",
            "fax_number": "704-761-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGTON",
        "first_name": "MARIANA",
        "middle_name": "ALYN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-03",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "2023-01553",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "11257",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.