NPIMap

Individual provider Active NPI

David Ellis, DPM

  • Foot & Ankle Surgery Podiatrist
  • Reno, NV
National Provider Identifier
1790349769
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
2082 Issued in NV
Practice address
10463 Double R Blvd
Reno, NV 89521-5866
Phone
(775) 358-2542
NPI assigned
Apr 25, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Foot & Ankle Surgery Podiatrist 213ES0103X 2082 NV Primary

Addresses

Primary practice location

10463 Double R Blvd
Reno, NV 89521-5866

Mailing address

10463 Double R Blvd
Reno, NV 89521-5866
Phone (775) 358-2542

Other practice location 1

20000 N 57th Ave Rm K201
Glendale, AZ 85308-6988
Phone (801) 227-9397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20220818002229 NV Practitioner - Podiatry 4688057938 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dr David Ellis DPM LLCGroup PAC ID 9436698511, 2 clinicians

Practice addresses (Care Compare)

10463 Double R Blvd
Suite 100
Reno, NV 89521-8908
Phone (775) 358-2542

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue113
Removal of skin lesions64
Removal of nail tissue997
Removal or shaving of skin growth566
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2082NVMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. David Ellis DPM LLC Foot & Ankle Surgery CurrentSince Jul 20, 2024 Accepting new patients

Locations

10463 Double R Blvd
Ste 100
Reno, NV 89521
Phone (775) 355-8812

Organizations & group practices 2

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1790349769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10463 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895215866",
            "telephone_number": "775-358-2542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10463 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895215866",
            "telephone_number": "775-358-2542"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20000 N 57th Ave Rm K201",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853086988",
            "country_code": "US",
            "telephone_number": "801-227-9397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-25",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NV",
            "license": "2082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.