NPIMap

Individual provider Active NPI

Rudy John Ellis Jr., MD

  • Orthopaedic Surgery Physician
  • Louisville, KY
National Provider Identifier
1740281583
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
19740 Issued in KY
Practice address
13151 Magisterial Dr
Ste 200
Louisville, KY 40223-4103
Phone
(502) 587-1236
Fax
(502) 587-0126
NPI assigned
Aug 2, 2005
Last updated
Apr 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 19740 KY Primary

Addresses

Primary practice location

13151 Magisterial Dr
Ste 200
Louisville, KY 40223-4103

Mailing address

13151 Magisterial Dr
Ste 200
Louisville, KY 40223-4103
Phone (502) 587-1236

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20081117000340 KY Practitioner - Orthopedic Surgery 3577623867 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Louisville School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13151 Magisterial Dr
Suite 200
Louisville, KY 40223-4103
Phone (502) 587-1236

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19740KYMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ellis & Badenhausen Orthopaedics, PSC Orthopaedic Surgery CurrentSince Jan 1, 1985 Accepting new patients
Ellis & Badenhausen Orthopaedics, PSC CurrentSince Feb 1, 1983 Accepting new patients
Ebo MRI, LLC Past Accepting new patients
Ellis & Badenhausen Orthopaedics,PSC Orthopaedic Surgery Past Accepting new patients

Locations

100 E Liberty St
Ste 600
Louisville, KY 40202
Phone (502) 228-5648

13151 Magisterial Dr
#200
Louisville, KY 40223

5120 Dixie Hwy
Ste 102
Louisville, KY 40216
Phone (502) 448-0931

5120 Dixie Hwy
Ste 103
Louisville, KY 40216
Phone (502) 449-0449

Interoperability endpoints

  • Direct secure messaging: john.ellis@eandbortho.directbygreenway.com

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, 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": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1740281583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13151 MAGISTERIAL DR",
            "address_2": "STE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402234103",
            "telephone_number": "502-587-1236",
            "fax_number": "502-587-0126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13151 MAGISTERIAL DR",
            "address_2": "STE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402234103",
            "telephone_number": "502-587-1236",
            "fax_number": "502-587-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "RUDY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "KY",
            "license": "19740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.