Jessica Ann Ellis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60394843 Issued in WA

Practice address

427 S Bernard St
Spokane, WA 99204-2509

Phone

(509) 456-0107

Fax

(509) 747-2635

NPI assigned

Aug 1, 2011

Sex

Female

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 WA, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Southern California College of Optometry, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grant W. Hardan OD PLLCGroup PAC ID 7810168622, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Grant W. Hardan OD PLLC

  • Clinic/Center
  • Spokane, WA
  • NPI 1962700344
  Medicare reassignment Care Compare group
• Wilson Polito PLLC

  • Optometrist
  • Lewiston, ID
  • NPI 1710276324
  Medicare reassignment NPD
• Stephen Brockbank O.D. L.L.C.

  • Optometrist
  • Lewiston, ID
  • NPI 1750511184
  NPD (past)

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

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442880000000",
    "number": "1619255262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 S BERNARD ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042509",
            "telephone_number": "509-456-0107",
            "fax_number": "509-747-2635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 S BERNARD ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042509",
            "telephone_number": "509-456-0107",
            "fax_number": "509-747-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-01",
        "last_updated": "2015-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60394843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER ID",
            "identifier": "12252261",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rena Elliott
• Jalai Ellis-Goings
• Daniel Adam Ellis, L.D.O.
• Erika Ellis, DPT
• James Randall Ellis, MA, LMHC
• Michael R Ellis, CRNA
• Stacie Ellis
• Aliece Ellisen, PTA
• Madison Ellison
• Charity A Elmendorf, ARNP

• Optometrist in Spokane, WA
• Providers in Spokane, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; 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.