NPIMap

Individual provider Active NPI

Tara Russell Ellis, NP

  • Nurse Practitioner
  • North Charleston, SC
National Provider Identifier
1659951739
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
25495 Issued in SC
Practice address
2680 Elms Plantation Blvd
North Charleston, SC 29406-7101
Phone
(843) 439-6181
NPI assigned
Apr 12, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 25495 SC Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

2680 Elms Plantation Blvd
North Charleston, SC 29406-7101

Mailing address

2680 Elms Plantation Blvd
North Charleston, SC 29406-7101
Phone (843) 813-2914

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20220407002627 SC Practitioner - Nurse Practitioner 5193111714 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients
University Medical Associates of the Medical University of South Carol Nurse Practitioner CurrentSince Jul 15, 2025 Accepting new patients
Hospice Care of South Carolina, LLC CurrentSince Mar 1, 2022 Accepting new patients
Hospice Care of South Carolina, LLC Past Accepting new patients

Locations

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

136 Stonemark Ln
Ste 100C
Columbia, SC 29210
Phone (888) 701-4661

136 Stonemark Ln
Ste 100
Columbia, SC 29210
Phone (803) 603-4821

123 Dillon Dr
Spartanburg, SC 29307
Phone (864) 573-9100

187 N Church St
Ste 201
Spartanburg, SC 29306
Phone (864) 630-8469

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 6

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": "1618185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1659951739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 ELMS PLANTATION BLVD",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294067101",
            "telephone_number": "843-813-2914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 ELMS PLANTATION BLVD",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294067101",
            "telephone_number": "843-439-6181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "TARA",
        "middle_name": "RUSSELL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-12",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "25495",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

Verify at the official NPI Registry.