NPIMap

Individual provider Active NPI

Cara Davidson Ellis, MD

  • Family Medicine Physician
  • Vancouver, WA
National Provider Identifier
1639303944
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60296002 Issued in WA
Practice address
315 SE Stone Mill Dr
Suite 102
Vancouver, WA 98684-6998
Phone
(360) 816-2700
NPI assigned
May 14, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X MD60296002 WA Primary

Addresses

Primary practice location

315 SE Stone Mill Dr
Suite 102
Vancouver, WA 98684-6998

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 2

IdentifierTypeStateIssuer
500649465MedicaidOR
P01178829OtherWARAILROAD MEDICARE - PHS

Other names 1

  • Cara C Davidson Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cellis139591@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20120925000843 WA Practitioner - Family Practice 7911155312 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Carolina at Chapel Hill School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
PeacehealthGroup PAC ID 8820178288, 245 clinicians

Practice addresses (Care Compare)

505 NE 87TH Ave
Vancouver, WA 98664-1965

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Vancouver, WA, CCN 507081
  • Peacehealth Southwest Home Health Home health agency, Vancouver, WA, CCN 507064
  • Providence Hospice Hospice, Portland, OR, CCN 381500
  • Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050
  • Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60296002WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Dec 30, 2024 Accepting new patients
Peacehealth CurrentSince Feb 25, 2025 Accepting new patients
Peacehealth Family Medicine CurrentSince Feb 25, 2025 Accepting new patients

Locations

1115 SE 164th Ave
Vancouver, WA 98683
Phone (360) 729-1412

505 NE 87th Ave
Ste 301
Vancouver, WA 98664
Phone (360) 514-1854

315 SE Stonemill Dr
Ste 102
Vancouver, WA 98684
Phone (360) 816-2700

1115 SE 164th Ave
Dept 364
Vancouver, WA 98683
Phone (360) 735-8100

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

315 SE Stonemill Dr
Vancouver, WA 98684
Phone (360) 729-8020

Interoperability endpoints

  • Direct secure messaging: cellis679597@direct.peacehealth.org
  • Direct secure messaging: cellis139591@oc.providencedirect.org

Organizations & group practices 3

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 9

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": "1242259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1639303944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 SE STONE MILL DR",
            "address_2": "SUITE 102",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846998",
            "telephone_number": "360-816-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CARA",
        "middle_name": "DAVIDSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-14",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60296002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500649465",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - PHS",
            "identifier": "P01178829",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cellis139591@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "315 SE Stone Mill Dr",
            "address_2": "SUITE 102",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986846998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CARA",
            "last_name": "DAVIDSON",
            "middle_name": "C",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.