Shaji Joseph Ellimuttil, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA14664 Issued in TX

Practice address

1100 Allied Dr
Plano, TX 75093-5348

Phone

(972) 977-9301

NPI assigned

Sep 1, 2021

Last updated

Sep 1, 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 TX

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

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ut of Texas Southwestern University Hospital - William P. Clements Jr. Hospital, Dallas, TX, CCN 450044

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• University of Texas Southwestern Medical Center at Dallas

  • Anesthesiology Physician
  • Dallas, TX
  • NPI 1942270566
  Medicare reassignment Care Compare group
• Texas Heart Hospital of the Southwest LLP

  • Nurse Practitioner
  • Plano, TX
  • NPI 1104164755

  Physician Assistant

  Medicare reassignment NPD
• Texas Heart Hospital of the Southwest LLC

  dba Baylor Scott & White Heart and Vascular Hospital - Dallas

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1609855139
  NPD
• The University of Texas Southwestern Medical Center at Dallas

  • Clinical Medical Laboratory
  • Dallas, TX
  • NPI 1396832713
  NPD
• University of Texas Southwestern Medical Center at Dallas

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1760452767
  NPD

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

• University of Texas Southwestern Medical Center at Dallas

  dba UT Southwestern University Hospital

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1285798918
  Care Compare affiliation

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1760150981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 KNIGHTSBRIDGE RD APT 5204",
            "city": "FARMERS BRANCH",
            "state": "TX",
            "postal_code": "752341378",
            "telephone_number": "972-977-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 ALLIED DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935348",
            "telephone_number": "972-977-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIMUTTIL",
        "first_name": "SHAJI",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA14664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa McGillvary Elkin
• Amyra Elkins
• Ellen Fan M D P a
• John Ellett, LPO
• Ellevecrown LLC
• Roseanne P Elling, PH.D
• David Bryan Elliott, LCSW
• Erin Elizabeth Elliott, MS, RD, LD, CDCES
• Kerian Elliott, DC
• Lauren Elliott, PA-C

• Physician Assistant in Plano, TX
• Providers in Plano, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.