Bobby J Ellis, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

26021 Issued in OK

Practice address

921 14TH Ave NW
Ardmore, OK 73401-1837

Phone

(580) 223-5311

Fax

(580) 223-8227

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Internal Medicine

Education

University of Kansas School of Med (KC/Wich/Sal), 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ideal Home Care, L.P. Home health agency, Ardmore, OK, CCN 377678
• Mays Housecall Home Health of Durant Home health agency, Durant, OK, CCN 377748
• Traditions Health of Purcell Home health agency, Purcell, OK, CCN 377520
• Mercy Hospital Ardmore, Inc Hospital, Ardmore, OK, CCN 370047

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bellis5126@directc.mercy.net

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.

• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550

  Internal Medicine, OK

  Medicare reassignment Care Compare group NPD
• Mercy Clinic Oklahoma Communities

  • Endocrinology, Diabetes & Metabolism Physician
  • Oklahoma City, OK
  • NPI 1750986295
  Care Compare group
• Mercy Hospital Oklahoma City, Inc

  • Diagnostic Radiology Physician
  • Yukon, OK
  • NPI 1730326406
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Health Watch Health Care of Weatherford, LLC

  • Home Health Agency
  • Durant, OK
  • NPI 1720480932
  Care Compare affiliation
• Ideal Home Care, LLC

  • Home Health Agency
  • Ardmore, OK
  • NPI 1467430595
  Care Compare affiliation
• Mercy Hospital Ardmore, Inc.

  • General Acute Care Hospital
  • Ardmore, OK
  • NPI 1386741635

  Hospital

  Care Compare affiliation
• Traditions Health Care of Purcell, LLC

  • Home Health Agency
  • Purcell, OK
  • NPI 1487390241
  Care Compare affiliation

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398729600000",
    "number": "1679595144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 W MEMORIAL RD",
            "address_2": "140",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341785",
            "telephone_number": "405-752-3162",
            "fax_number": "405-936-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 14TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011837",
            "telephone_number": "580-223-5311",
            "fax_number": "580-223-8227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BOBBY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2014-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "0417821",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "26021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200128140A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Eidson
• Melissa Eldred
• Nicole Elkins, PA-C
• Brooke Elliott, BHRS
• Penny Elliott, LPC
• Jared Scott Ellsworth, PA
• Elmbrook Clinical Services LLC
• Elmbrook Home, Inc.
• Travis Elmore
• Whitney Dawn Elmore, B.A

• All providers in Ardmore, OK
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.