Andrew P Ellis, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

1396 Issued in OR

Practice address

1815 SW Marlow
Suite 110
Portland, OR 97225-5185

Phone

(503) 292-0765

Fax

(503) 292-5208

NPI assigned

Sep 11, 2006

Last updated

Dec 15, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brain Rehab Network Oregon IncGroup PAC ID 8729400510, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brain Rehab Network Oregon, Inc.

  • Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
  • Tigard, OR
  • NPI 1134595002
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1730283813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7204 SW DURHAM RD",
            "address_2": "STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247574",
            "telephone_number": "503-941-9869",
            "fax_number": "503-352-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 SW MARLOW",
            "address_2": "SUITE 110",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255185",
            "telephone_number": "503-292-0765",
            "fax_number": "503-292-5208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ANDREW",
        "middle_name": "P",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "OR",
            "license": "1396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Christine Elliott, CPM
• Tara Elliott
• Timothy J Elliott, DMD
• Alexandria Ellis, CSWA
• Amber Ellis
• Brandon Ellis, LMT
• David Andrew Ellis, M.D.
• Erin Ellis
• Evan Eugene Ellis, PCA
• Favor Sharee Ellis

• Clinical Neuropsychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Neuropsychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.