Active NPI
Killian Ellis, PA-C
- Physician Assistant
- Charleston, WV
National Provider Identifier
1740879394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 4500 Maccorkle Ave SE
Charleston, WV 25304-1806 - Phone
- (304) 926-1001
- NPI assigned
- Jan 18, 2021
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
4500 Maccorkle Ave SE
Charleston, WV 25304-1806
Mailing address
16 Sugar Maple LN
Ona, WV 25545-3500
Phone (304) 360-5498
Other practice location 1
111 Morning Star Ln
Beckley, WV 25801-7118
Phone (304) 252-3900
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | mycarewvke@gmail.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2456 | WV | MD | Occupational Therapist |
Organizations & group practices 1
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.
-
- Phlebology Physician
- Beckley, WV
- NPI 1437677838
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610928000000",
"number": "1740879394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 SUGAR MAPLE LN",
"city": "ONA",
"state": "WV",
"postal_code": "255453500",
"telephone_number": "304-360-5498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041806",
"telephone_number": "304-926-1001"
}
],
"practiceLocations": [
{
"address_1": "111 Morning Star Ln",
"address_purpose": "LOCATION",
"city": "Beckley",
"state": "WV",
"postal_code": "258017118",
"country_code": "US",
"telephone_number": "304-252-3900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELLIS",
"first_name": "KILLIAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-18",
"last_updated": "2021-01-18",
"certification_date": "2021-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "mycarewvke@gmail.com",
"affiliation": "N",
"address_1": "4500 MacCorkle Ave SE",
"city": "Charleston",
"state": "WV",
"country_code": "US",
"postal_code": "253041806",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.