Mark H. Ellis, M.D.

Primary specialty

Pediatric Allergy/Immunology PhysicianTaxonomy code 2080P0201X

License

C41445 Issued in CA

Practice address

455 S Main St
Orange, CA 92868-3835

Phone

(714) 289-4511

Fax

(714) 289-4788

NPI assigned

Sep 20, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Allergy/Immunology

Education

Tulane University School of Medicine, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Childrens Hospital of Orange CountyGroup PAC ID 6406944883, 70 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Children'S Hospital of Orange County

  • Pediatrics Physician
  • Orange, CA
  • NPI 1275975104

  Pediatric Allergy/Immunology

  Medicare reassignment Care Compare group NPD
• Children'S Hospital of Orange County

  • Children's Hospital
  • Orange, CA
  • NPI 1811080526
  NPD (past)
• Orange County Global Medical Center, Inc

  • General Acute Care Hospital
  • Santa Ana, CA
  • NPI 1982697678
  NPD (past)
• St Joseph Hospital of Orange

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1912982216
  NPD (past)
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Eureka, CA
  • NPI 1609858950
  NPD (past)
• University of California Irvine

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1689608150
  NPD (past)
• Memorial Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Phoenix, AZ
  • NPI 1255523643
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568569424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683835",
            "telephone_number": "714-289-4511",
            "fax_number": "714-289-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683835",
            "telephone_number": "714-289-4511",
            "fax_number": "714-289-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARK",
        "middle_name": "H.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "CA",
            "license": "C41445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C414450",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cindy Shinwon Ellington, MFT
• Ahmad Reza Ellini, MD
• Caryn Ashley Ellis
• Cristina Ellis
• Hannah Ellis
• Samantha Jo Ellis
• Alanni Ellsberry
• Elizabeth Elm, BA
• Elmira Latshikyan Dental Corporation
• Victoria Monique Elmquist

• Pediatric Allergy/Immunology Physician in Orange, CA
• Providers in Orange, CA by specialty
• Pediatric Allergy/Immunology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.