Jeanne M Ellern, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10003760 Issued in WA

Practice address

1807 N Hutchinson Rd
Spokane Valley, WA 99212-2444

Phone

(509) 456-7414

Fax

(509) 624-0763

NPI assigned

Apr 5, 2006

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 WA, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain West Derm - Blackhart PLLCGroup PAC ID 1153609813, 103 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Spokane Valley, WA
  • NPI 1013557933

  Dermatology, WA

  Medicare reassignment Care Compare group NPD
• Mountain West Derm-Blackhart, PLLC

  • Dermatology Physician
  • Boise, ID
  • NPI 1548758501

  ID

  Medicare reassignment Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Ambulatory Surgical Clinic/Center
  • Spokane Valley, WA
  • NPI 1619517539
  Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Anchorage, AK
  • NPI 1124670088
  Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Georgetown, TX
  • NPI 1366018848
  Care Compare group
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Bend, OR
  • NPI 1447764741
  Care Compare group
• Mountain West Derm - Blackhart PLLC

  • MOHS-Micrographic Surgery Physician
  • Reno, NV
  • NPI 1740633015
  Care Compare group
• Advanced Dermatology and Skin Surgery PLLC

  • Clinical Medical Laboratory
  • Spokane Valley, WA
  • NPI 1972579845
  NPD
• Mountain West Derm-Blackhart, PLLC

  • Dermatology Physician
  • Tigard, OR
  • NPI 1316656994

  Dermatology

  NPD
• Inland Imaging Associates PS

  • Surgical Physician Assistant
  • Spokane, WA
  • NPI 1770544512

  Medical

  NPD (past)
• Dermatology Associates,P.C.

  • Specialist
  • Tigard, OR
  • NPI 1851442461
  NPD (past)

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407974400000",
    "number": "1689636649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 N HUTCHINSON RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992122444",
            "telephone_number": "509-456-7414",
            "fax_number": "509-624-0763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 N HUTCHINSON RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992122444",
            "telephone_number": "509-456-7414",
            "fax_number": "509-624-0763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERN",
        "first_name": "JEANNE",
        "middle_name": "M",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2014-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003760",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10003760",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven El-Ayache
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• Elements Therapeutic Massage-Valley
• Taylor Eley
• Laura Kathleen Elias
• Jamie Lee Ellertsen, CDP
• Ellingsen -Paxton DDS PS
• Ellingsen and Denison Endodontics, PLLC
• Ellingsen Endodontics PLLC
• Elise Kathryn Ellingsen Miller, DDS, MSD

• All providers in Spokane Valley, WA
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.