Ellen Fan M D P a

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

K8897 Issued in TX

Legal business name

ELLEN FAN M D P A

Practice address

8240 Manderville LN
Dallas, TX 75231-1104

Phone

(972) 769-8572

Fax

(972) 769-8591

NPI assigned

Jun 5, 2013

Last updated

May 29, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ellen Fan, M.D.NPI 1134153646

Title

Physician

Phone

(972) 769-8572

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Ellen Fan M D P a

  • Geriatric Psychiatry Physician
  • Plano, TX
  • NPI 1982742276

  O20050512001017

  Same enrollment

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ellen Fan, M.D.

  • Geriatric Psychiatry Physician
  • Plano, TX
  • NPI 1134153646
  Authorized official Same address or phone

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

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1467890178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 PRESTON RD",
            "address_2": "SUITE 350 BOX 242",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750937453",
            "telephone_number": "972-769-8572",
            "fax_number": "972-769-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8240 MANDERVILLE LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752311104",
            "telephone_number": "972-769-8572",
            "fax_number": "972-769-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN FAN M D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-05",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "972-769-8572",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "TX",
            "license": "K8897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179654201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Richard Frank Eller, M.D.
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• Heather Lea Ellett, LPC
• William Bryan Ellett, L.AC.
• Ellie & P Health

• Geriatric Psychiatry Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Geriatric Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.