NPIMap

Individual provider Active NPI

Thomas S Ellis, M.D.

  • Neurological Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1629004445
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
H9911 Issued in TX
Practice address
1900 Mistletoe Blvd Ste 200
Fort Worth, TX 76104
Phone
(817) 878-5333
Fax
(817) 878-5334
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X H9911 TX Primary

Addresses

Primary practice location

1900 Mistletoe Blvd Ste 200
Fort Worth, TX 76104

Mailing address

1900 Mistletoe Blvd Ste 200
Fort Worth, TX 76104-4049
Phone (817) 878-5333

Other identifiers 2

IdentifierTypeStateIssuer
089947804MedicaidTX
8H9671OtherTXBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100910000644 TX Practitioner - Neurosurgery 4880677814 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Texas Medical School at Houston, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fort Worth Brain and Spine Institute, LLPGroup PAC ID 0840273868, 11 clinicians
Green Oaks Physical Therapy Limited PartnershipGroup PAC ID 4688582141, shared by 2 NPIs, 208 clinicians

Practice addresses (Care Compare)

1900 Mistletoe Blvd
Suite 200
Fort Worth, TX 76104-4049
Phone (817) 878-5333

350 Mercedes St
Benbrook, TX 76126-2593
Phone (817) 717-5390

Hospital & facility affiliations

  • Enhabit Home Health Home health agency, Fort Worth, TX, CCN 679167
  • Enhabit Home Health Home health agency, Granbury, TX, CCN 679021
  • Encompass Home Health of DFW Home health agency, Grapevine, TX, CCN 679428
  • Enhabit Home Health Home health agency, Abilene, TX, CCN 679184
  • Baylor Scott and White Surgical Hospital Fortworth Hospital, Fort Worth, TX, CCN 450880
  • Medical City Fort Worth Hospital, Fort Worth, TX, CCN 450672
  • Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135
  • Lake Granbury Medical Center Hospital, Granbury, TX, CCN 450596
  • Baylor Institute for Rehabilitation at Fort Worth Inpatient rehabilitation facility, Fort Worth, TX, CCN 673035

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion194
Laminectomy or laminotomy (partial removal of spine bones)72

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
H9911TXMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Worth Brain & Spine Institute, LLP Neurological Surgery CurrentSince Apr 15, 2003 Accepting new patients
Healthtexas Provider Network CurrentSince Nov 6, 2023 Accepting new patients
Healthtexas Provider Network CurrentSince Nov 6, 2023 Accepting new patients
Healthtexas Provider Network Current Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

1900 Mistletoe Blvd
Ste 200
Ft Worth, TX 76104

Interoperability endpoints

  • Direct secure messaging: tellis@direct.uspi.com

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 10

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1629004445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044049",
            "telephone_number": "817-878-5333",
            "fax_number": "817-878-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-878-5333",
            "fax_number": "817-878-5334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "THOMAS",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "H9911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "089947804",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8H9671",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.