NPIMap

Individual provider Active NPI

Donald Ellis, M.D.

  • Family Medicine Physician
  • Oscoda, MI
National Provider Identifier
1700893377
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301070492 Issued in MI
Practice address
5939 N Huron Rd
Oscoda, MI 48750-9710
Phone
(989) 739-1441
Fax
(989) 739-6093
NPI assigned
Aug 3, 2006
Last updated
Feb 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301070492 MI Primary

Addresses

Primary practice location

5939 N Huron Rd
Oscoda, MI 48750-9710

Mailing address

PO Box 779
Tawas City, MI 48764-0779
Phone (989) 739-1441

Other identifiers 1

IdentifierTypeStateIssuer
4209088MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address donellis@smomsjhs.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20100605000220 MI Practitioner - Family Practice 9133278245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progress Physical Therapy IncGroup PAC ID 5698669919, 23 clinicians
Mymichigan Medical Center TawasGroup PAC ID 9638070766, 36 clinicians

Practice addresses (Care Compare)

3076 Northridge Rd
Hale, MI 48739-9277
Phone (989) 728-0242

3190 Northridge Rd
Mymichigan Family Medicine
Hale, MI 48739-9276
Phone (989) 728-4211

5939 N Huron Rd
Mymichigan Family Medicine
Oscoda, MI 48750-9710
Phone (989) 739-1441

Hospital & facility affiliations

Procedures performed for Medicare patients

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

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Tawas Current Accepting new patients
Mymichigan Medical Center Tawas Family Medicine Current Accepting new patients
Mymichigan Medical Center Tawas Family Medicine CurrentSince Jul 1, 2000 Accepting new patients
Mymichigan Medical Center Tawas CurrentSince Jul 1, 2000 Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients

Locations

1392 Maple Dr
Fairview, MI 48621
Phone (989) 848-5644

3190 Northridge Rd
Hale, MI 48739
Phone (989) 728-4211

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

5939 N Huron Rd
Oscoda, MI 48750
Phone (989) 739-1147

200 Hemlock Rd
Tawas City, MI 48763
Phone (989) 362-3411

325 E M 55
Ste B
Tawas City, MI 48763
Phone (989) 362-4626

Interoperability endpoints

  • Direct secure messaging: donald.ellis.1@11016.direct.athenahealth.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677110400000",
    "number": "1700893377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 779",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487640779",
            "telephone_number": "989-739-1441",
            "fax_number": "989-739-6093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5939 N HURON RD",
            "city": "OSCODA",
            "state": "MI",
            "postal_code": "487509710",
            "telephone_number": "989-739-1441",
            "fax_number": "989-739-6093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DONALD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301070492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4209088",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "donellis@smomsjhs.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "5939 N Huron Rd",
            "city": "Oscoda",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487509710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oscoda, MI

Sources for this page

Verify at the official NPI Registry.