Individual provider Active NPI

Tina Marie Ellis, MD

  • Anesthesiology Physician
  • Providence, RI
National Provider Identifier
1497072631
Registry record updated Mar 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD14603 Issued in RI
Practice address
593 Eddy St
Davol 129
Providence, RI 02903-4923
Phone
(401) 444-4933
NPI assigned
Apr 28, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD14603 RI Primary

Addresses

Primary practice location

593 Eddy St
Davol 129
Providence, RI 02903-4923

Mailing address

1 Virginia Ave Ste 201
Providence, RI 02905-4444
Phone (401) 490-0927

Other practice location 1

101 Dudley St
Providence, RI 02905-2401
Phone (401) 274-1122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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

Enrollment IDStateProvider typePAC IDDetails
I20140808001682 RI Practitioner - Anesthesiology 9436376787 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Florida College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-6966

Hospital & facility affiliations

  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007
  • The Miriam Hospital Hospital, Providence, RI, CCN 410012

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Corporation Current Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: tellis6339@brownhealth.medalliesdirect.net

Organizations & group practices 4

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 5

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": "1272412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774569600000",
    "number": "1497072631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VIRGINIA AVE STE 201",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054444",
            "telephone_number": "401-490-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "DAVOL 129",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-4933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Dudley St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029052401",
            "country_code": "US",
            "telephone_number": "401-274-1122",
            "fax_number": "401-453-7666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-28",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "RI",
            "license": "MD14603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.