Individual provider Active NPI

Casey Coldiron Ellis, PA-C

  • Physician Assistant
  • Fort Bragg, NC
National Provider Identifier
1730813841
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12477 Issued in NC
Practice address
Womack 2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001
Phone
(910) 907-6000
NPI assigned
Jul 13, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X 0010-12477 NC Primary

Addresses

Primary practice location

Womack 2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001

Mailing address

Womack 2817 Rock Merritt Ave
Fort Bragg, NC 28310-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240319001628 NC Practitioner - Physician Assistant 2466899091 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinehurst Medical Clinic IncGroup PAC ID 5991617169, 162 clinicians

Practice addresses (Care Compare)

15 Regional Dr
Pinehurst, NC 28374-8850
Phone (910) 295-5511

200 Pavilion Way
Southern Pines, NC 28387-4561
Phone (910) 295-5511

205 Page Rd
Pinehurst, NC 28374-8749
Phone (910) 295-5511

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0010-12477NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pinehurst Medical Clinic, Inc. Single Specialty CurrentSince Dec 1, 2023 Accepting new patients
Pinehurst Medical Clinic, Inc. Past Accepting new patients

Locations

205 Page Rd
Pinehurst, NC 28374
Phone (910) 295-9211

555 Carthage St
Sanford, NC 27330
Phone (919) 774-6518

200 Pavilion Way
Southern Pines, NC 28387
Phone (910) 235-3330

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749686400000",
    "number": "1730813841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WOMACK 2817 ROCK MERRITT AVE",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WOMACK 2817 ROCK MERRITT AVE",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CASEY",
        "middle_name": "COLDIRON",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-13",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Bragg, NC

Sources for this page

Verify at the official NPI Registry.