Individual provider Active NPI

Nathan Christopher Ellis, MD

  • Emergency Medicine Physician
  • Erie, PA
National Provider Identifier
1801457528
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MT219303 Issued in PA
Practice address
232 W 25TH St
Erie, PA 16544-0002
Phone
(814) 452-5101
NPI assigned
Jun 24, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MT219303 PA Primary

Addresses

Primary practice location

232 W 25TH St
Erie, PA 16544-0002

Mailing address

232 W 25TH St
Erie, PA 16544-0002
Phone (814) 452-5101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240210000328 UT Practitioner - Emergency Medicine 1456746221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Oklahoma College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Valley Emergency Physicians LCGroup PAC ID 4789630401, 16 clinicians

Practice addresses (Care Compare)

170 N 1100
American Fork, UT 84003-2096
Phone (801) 714-6570

Hospital & facility affiliations

  • American Fork Hospital Hospital, American Fork, UT, CCN 460023

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT219303PAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Valley Emergency Physicians LC CurrentSince Oct 1, 2023 Accepting new patients

Locations

170 N 1100 E
American Fork, UT 84003
Phone (801) 714-6570

392 W Medical Dr
Saratoga Springs, UT 84045
Phone (801) 253-6554

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.

Hospital & facility affiliations 2

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": "1561334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561334400000",
    "number": "1801457528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 W 25TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165440002",
            "telephone_number": "814-452-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 W 25TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165440002",
            "telephone_number": "814-452-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "NATHAN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MT219303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.