Derek Ellingson, D.O.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

02006527A Issued in IN

Practice address

7950 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Phone

(260) 435-7001

NPI assigned

Aug 30, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in AK, WA2 enrollments

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 2

Specialty

Pathology

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cellnetix Pathology PLLCGroup PAC ID 8224062971, shared by 3 NPIs, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Alaska Regional Hospital Hospital, Anchorage, AK, CCN 020017
• Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006
• Providence Alaska Medical Center Hospital, Anchorage, AK, CCN 020001
• Swedish Medical Center Hospital, Seattle, WA, CCN 500027

Merit-based Incentive Payment System (MIPS)

Final score

76.55 of 100Reported as group

Quality

72.42

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Cellnetix Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Everett, WA
  • NPI 1356310866
  Medicare reassignment NPD
• Cellnetix Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Palmer, AK
  • NPI 1508129628
  Medicare reassignment NPD
• Cellnetix Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Tucson, AZ
  • NPI 1598624207
  NPD
• Cellnetix Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Seattle, WA
  • NPI 1972563385
  NPD
• Associated Pathologists LLC

  • Clinical Medical Laboratory
  • Nashville, TN
  • NPI 1124075635
  NPD (past)

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

• Galen Hospital Alaska, Inc.

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1952348047
  Care Compare affiliation
• Mat-Su Valley Medical Center LLC

  • General Acute Care Hospital
  • Palmer, AK
  • NPI 1417975061
  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1053363119
  Care Compare affiliation
• Swedish Health Services

  • General Acute Care Hospital
  • Seattle, WA
  • NPI 1306992151
  Care Compare affiliation

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1487848644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 AIRPARK CENTER DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372175200",
            "telephone_number": "615-221-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-435-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-30",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IA",
            "license": "DO05260",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AK",
            "license": "MEDO7423",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MO",
            "license": "2007018750",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "02006527A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Esther Elias, NP
• Elite Limousine & Taxi
• Hoda Elkholy
• Emily Claussen Elko, PA-C
• Ella'S House Home Care, LLC
• Patrice C Ellingson, O.D.
• Julia A. Ellingwood, FNP-C
• Charles Chase Ellinwood, DDS
• Steven Penn Ellinwood, DDS
• Alicia A Elliott, CNS

• Anatomic Pathology & Clinical Pathology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Anatomic Pathology & Clinical Pathology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.