Active NPI
John M Ellis, MD
- Neurology Physician
- Methuen, MA
National Provider Identifier
1720057755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 58546
- Practice address
- 70 East Street
Valley Regional Medical Services
Methuen, MA 01844 - Phone
- (978) 688-0773
- Fax
- (978) 681-6173
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 58546 | MA | Primary |
Addresses
Primary practice location
70 East Street
Valley Regional Medical Services
Methuen, MA 01844
Mailing address
77 Warren St
RM 339
Brighton, MA 02135
Phone (617) 562-5359
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3032701 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Regional Medical Services | Past | Accepting new patients | |
| Valley Regional Medical Services | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Specialist
- Methuen, MA
- NPI 1780675538
-
- Specialist
- Salem, NH
- NPI 1871770693
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235347200000",
"number": "1720057755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 WARREN ST",
"address_2": "RM 339",
"city": "BRIGHTON",
"state": "MA",
"postal_code": "02135",
"telephone_number": "617-562-5359",
"fax_number": "617-562-5415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 EAST STREET",
"address_2": "VALLEY REGIONAL MEDICAL SERVICES",
"city": "METHUEN",
"state": "MA",
"postal_code": "01844",
"telephone_number": "978-688-0773",
"fax_number": "978-681-6173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JOHN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2009-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MA",
"license": "58546",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3032701",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Methuen, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.