Active NPI
Danielle Imani Ellis, MD
- Surgery Physician
- Medford, MA
National Provider Identifier
1740817469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 295571
- Practice address
- 75 Riverside Ave Ste 4
Medford, MA 02155-4600 - Phone
- (781) 396-8224
- NPI assigned
- Mar 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 295571 | MA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
75 Riverside Ave Ste 4
Medford, MA 02155-4600
Mailing address
PO Box 24300
New York, NY 10087-4300
Phone (781) 744-8771
Other practice location 1
55 Fruit St
Boston, MA 02114-2621
Phone (617) 726-2803
Other practice location 2
2014 Washington St
Newton, MA 02462-1607
Phone (617) 726-2803
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- dellis28666@direct.bostonchildrens.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787702400000",
"number": "1740817469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 24300",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100874300",
"telephone_number": "781-744-8771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 RIVERSIDE AVE STE 4",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554600",
"telephone_number": "781-396-8224"
}
],
"practiceLocations": [
{
"address_1": "55 Fruit St",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021142621",
"country_code": "US",
"telephone_number": "617-726-2803",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2014 Washington St",
"address_purpose": "LOCATION",
"city": "Newton",
"state": "MA",
"postal_code": "024621607",
"country_code": "US",
"telephone_number": "617-726-2803",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELLIS",
"first_name": "DANIELLE",
"middle_name": "IMANI",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-24",
"last_updated": "2026-08-26",
"certification_date": "2026-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MA",
"license": "295571",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; 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.