John C Ellis, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

R8E78 Issued in MO

Practice address

4880 NE Goodview Circle
Lees Summit, MO 64064

Phone

(816) 478-4200

Fax

(816) 478-0507

NPI assigned

Feb 14, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

University of Missouri, Kansas City, School of Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carroll County Memorial HospitalGroup PAC ID 2860485638, 64 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carroll County Memorial Hospital Hospital, Carrollton, MO, CCN 261332

Merit-based Incentive Payment System (MIPS)

Final score

69.76 of 100Reported as group

Quality

46.12

Promoting interoperability

100

Improvement activities

40

Cost

53.08

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/9785b033-fa30-4746-84ca-c07c9380c88e/
• FHIR API: https://fhir-usa.unify.chbase.com/org/carrcmh-bfcca679

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.

• Carroll County Memorial Hospital

  • Critical Access Hospital
  • Carrollton, MO
  • NPI 1528067113
  Medicare reassignment Care Compare group NPD
• Western Missouri Medical Center

  dba Surgical Services of Warrensburg

  • Surgery Physician
  • Warrensburg, MO
  • NPI 1386832277
  Medicare reassignment NPD
• Carroll County Memorial Hospital

  dba Carroll County Memorial Hospital Home Health Care Agency

  • Home Health Agency
  • Carrollton, MO
  • NPI 1205831013
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carroll County Memorial Hospital

  • Critical Access Hospital
  • Carrollton, MO
  • NPI 1528067113
  Care Compare affiliation

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1477527877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 NE RALPH POWELL RD",
            "address_2": "SUITE B",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642368",
            "telephone_number": "816-875-2599",
            "fax_number": "816-875-2598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4880 NE GOODVIEW CIRCLE",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "64064",
            "telephone_number": "816-478-4200",
            "fax_number": "816-478-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JOHN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "R8E78",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "204510882",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4001449",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BNDD",
            "identifier": "9852",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "11540041",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "1008021",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Lee's Summit, MO
• Providers in Lee's Summit, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.