Tina Ellis, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F03200290 Issued in MS

Practice address

7321 Eastover Blvd
Olive Branch, MS 38654-1413

Phone

(813) 716-7611

NPI assigned

Jun 17, 2021

Sex

Female

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 TN, MS, MD, CO, UT, FL6 enrollments

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 6

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559

  Family

  Medicare reassignment NPD
• Carr PLLC

  • Emergency Medicine Physician
  • Brentwood, TN
  • NPI 1548677610
  Medicare reassignment NPD
• T M Carr MD PC

  • Emergency Medicine Physician
  • Dyersburg, TN
  • NPI 1992706097
  Medicare reassignment NPD
• Mecnb, LLC

  • General Practice Physician
  • Palm Springs, FL
  • NPI 1427209352
  Medicare reassignment
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  CO, MD, TN

  Medicare reassignment
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  MS, UT

  Medicare reassignment
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1770152415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7321 EASTOVER BLVD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541413",
            "telephone_number": "813-716-7611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7321 EASTOVER BLVD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541413",
            "telephone_number": "813-716-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "TINA",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-17",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "F03200290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Mardis Durley, PT
• East Park Counseling Services LLC
• Edward Burris Eldred, D.O.
• Elite Practice Management
• Ashley Ellis, PHARM.D.
• Tina Marie Erber, PT
• Deborah Lynne Evans, PT
• L Gregory Evans, DDS
• Excellence Concierge Medicine LLC
• Exos Physical Therapy & Sports Medicine, LLC

• Family Nurse Practitioner in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.