Colette Mark Ellis, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

S8030 Issued in TX

Practice address

1059 Baywood Dr
Fairborn, OH 45324-2647

Phone

(713) 339-0341

NPI assigned

Apr 2, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Robert Marriott Medical Corp

  • Surgery Physician
  • El Segundo, CA
  • NPI 1083883938

  TX

  Medicare reassignment NPD
• Vohra Post Acute Care Physicians of Texas, PLLC

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1821424789

  General Practice

  Medicare reassignment NPD
• Robert Marriott Medical Corp

  • Surgery Physician
  • San Antonio, TX
  • NPI 1356892962
  NPD
• Premier Provider Health PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1235280496
  NPD (past)
• Premier Provider Health PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1700032745
  NPD (past)
• Winnie-Stowell Hospital District

  • Skilled Nursing Facility
  • Richwood, TX
  • NPI 1093232084
  NPD (past)

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1629530225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 BAYWOOD DR",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453242647",
            "telephone_number": "713-339-0341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1059 BAYWOOD DR",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453242647",
            "telephone_number": "713-339-0341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "COLETTE",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-02",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "S8030",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "S8030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelton Dale Eldridge
• Electric Mobility Corporation
• Chad Elkins, RPH
• Lorianne Elliott
• Renee Elliott
• Kyla Elswick
• Joy Michelle Ely, RPH
• Faith Lynn England
• Phyllis Engle
• Equal People, LLC

• General Practice Physician in Fairborn, OH
• Providers in Fairborn, OH by specialty
• General Practice Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.