NPIMap

Individual provider Active NPI

Madge Ellis, M.D.

  • Surgery Physician
  • Salem, VA
National Provider Identifier
1619954948
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0101229254 Issued in VA
Practice address
1898 Braeburn Dr
Salem, VA 24153-7301
Phone
(540) 772-3008
Fax
(540) 772-3352
NPI assigned
Dec 28, 2005
Last updated
Nov 12, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 0101229254 VA Primary

Addresses

Primary practice location

1898 Braeburn Dr
Salem, VA 24153-7301

Mailing address

1898 Braeburn Dr
Salem, VA 24153-7301
Phone (540) 772-3008

Other identifiers 1

IdentifierTypeStateIssuer
007311974MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211229001671 NC Practitioner - General Surgery 3971523358 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

212 Smith Church Rd
Roanoke Rapids, NC 27870-4914
Phone (252) 537-1717

220 Smith Church Rd
Roanoke Rapids, NC 27870-4914
Phone (252) 537-9268

250 Smith Church Rd
Roanoke Rapids, NC 27870-4914
Phone (252) 535-8240

401 A N Main St
Kenansville, NC 28349-8801
Phone (910) 296-0941

401 N Main St
Kenansville, NC 28349-8801
Phone (910) 296-0941

417 N Main St
Kenansville, NC 28349-8801
Phone (910) 296-8080

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Dec 15, 2021 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Oct 7, 2021 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Vidant Medical Group LLC CurrentSince Dec 15, 2021 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Surgery CurrentSince Oct 7, 2021 Accepting new patients
Carolinas Physicians Network Inc Surgery CurrentSince Oct 7, 2021 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Oct 7, 2021 Accepting new patients
Carolinas Physicians Network, Inc Past Accepting new patients

Locations

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

441 McAlister Rd
Ste 2100
Lincolnton, NC 28092
Phone (980) 212-6250

200 W Grover St
Shelby, NC 28150
Phone (704) 487-8591

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1619954948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1898 BRAEBURN DR",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241537301",
            "telephone_number": "540-772-3008",
            "fax_number": "540-772-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1898 BRAEBURN DR",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241537301",
            "telephone_number": "540-772-3008",
            "fax_number": "540-772-3352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MADGE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-28",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101229254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007311974",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, VA

Sources for this page

Verify at the official NPI Registry.