Active NPI
Jill Marie Ellis, P.A.
- Physician Assistant
- Troy, MI
National Provider Identifier
1720052483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601003809
- Practice address
- 4967 Crooks Rd Ste 130
Troy, MI 48098-5812 - Phone
- (248) 952-1601
- Fax
- (248) 952-0192
- NPI assigned
- Feb 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601003809 | MI | Primary |
Addresses
Primary practice location
4967 Crooks Rd Ste 130
Troy, MI 48098-5812
Mailing address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000
Other names 1
- Jill Marie Visser
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Rest Christian Mental Health Services | Current | Accepting new patients | |
| Pine Rest Christian Mental Health Services | Current | Accepting new patients | |
| Grand Rapids Addiction Medicine Specialists PC | Past | Accepting new patients | |
| Hospitalists of West Michigan PC | Past | Accepting new patients |
Locations
300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000
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.
-
- General Practice Physician
- Grand Rapids, MI
- NPI 1851309884
-
- Professional Counselor
- Grand Rapids, MI
- NPI 1386015683
-
- Internal Medicine Physician
- Grand Rapids, MI
- NPI 1780642355
-
- Infusion Therapy Clinic/Center
- Grand Rapids, MI
- NPI 1942334636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1720052483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4967 CROOKS RD STE 130",
"city": "TROY",
"state": "MI",
"postal_code": "480985812",
"telephone_number": "248-952-1601",
"fax_number": "248-952-0192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JILL",
"middle_name": "MARIE",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-17",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601003809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JILL",
"last_name": "VISSER",
"middle_name": "MARIE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.