Victoria Nicole Ellis, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

01166 Issued in WV

Practice address

200 Vance St
Chapmanville, WV 25508-9422

Phone

(304) 855-0425

Fax

(304) 855-0427

NPI assigned

Aug 25, 2008

Sex

Female

Sole proprietor

No

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.

• Lincoln County Primary Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hamlin, WV
  • NPI 1942274543

  WV

  Medicare reassignment Care Compare group NPD
• Lincoln County Primary Care Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Logan, WV
  • NPI 1023331220
  Care Compare group NPD
• Lincoln County Primary Care Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Hamlin, WV
  • NPI 1962583054
  Care Compare group NPD
• Lincoln County Primary Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chapmanville, WV
  • NPI 1396052528
  Care Compare group NPD
• Lincoln County Primary Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Man, WV
  • NPI 1689997678
  Care Compare group NPD
• Lincoln County Primary Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Gilbert, WV
  • NPI 1942523931
  Care Compare group NPD
• Lincoln County Primary Care Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Man, WV
  • NPI 1447619416
  Care Compare group NPD (past)
• Lincoln County Primary Care Center Inc

  • Federally Qualified Health Center (FQHC)
  • Hamlin, WV
  • NPI 1013675461
  Care Compare group
• Lincoln County Primary Care Center Inc

  • Federally Qualified Health Center (FQHC)
  • Chapmanville, WV
  • NPI 1043010630
  Care Compare group
• Lincoln County Primary Care Center Inc

  • Federally Qualified Health Center (FQHC)
  • Van, WV
  • NPI 1073310629
  Care Compare group
• Lincoln County Primary Care Center Inc

  • Federally Qualified Health Center (FQHC)
  • Hamlin, WV
  • NPI 1326705724
  Care Compare group
• Lincoln County Primary Care Center Inc

  • Community/Retail Pharmacy
  • Gilbert, WV
  • NPI 1467925487
  Care Compare group

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lincoln County Primary Care Center Inc 40 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: victoria.nicole.ellis.1@6401.direct.athenahealth.com
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1832

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 27, 2013.

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1467609149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 LYNN AVE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231138",
            "telephone_number": "304-824-5806",
            "fax_number": "304-824-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 VANCE ST",
            "city": "CHAPMANVILLE",
            "state": "WV",
            "postal_code": "255089422",
            "telephone_number": "304-855-0425",
            "fax_number": "304-855-0427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "VICTORIA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-25",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "01166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810020410",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Elkins
• Ellen Mary Cabe
• Alexa Ellis
• Patrick M Ellis, MSPT
• Sarah Beth Ellis
• Tekisha Eubanks
• Dana Rose Evans, LPC
• Athena Nicole Farley
• Lawana Farley
• Patricia Ann Farley

• All providers in Chapmanville, WV
• Medical Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; 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.