NPIMap

Individual provider Active NPI

Jim Patrick Ellison, M.D.

  • Nephrology Physician
  • Winston Salem, NC
National Provider Identifier
1811251291
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
2021-00081 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-2375
Phone
(336) 716-6410
NPI assigned
Jun 29, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 32955 AL
Nephrology Physician 207RN0300X 2021-00081 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-2375

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-6410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20230822003723 NC Practitioner - Nephrology 0749402139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Alabama School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32955ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Vitalium Partners PLLC Nephrology Current Accepting new patients
Wake Forest University Health Sciences CurrentSince Aug 1, 2023 Accepting new patients
Internal Medicine Associates of Tuscaloosa, P.C. PastSince Mar 27, 2022 Accepting new patients

Locations

1370 W D St
North Wilkesboro, NC 28659
Phone (336) 651-8100

1917 W Park Dr
North Wilkesboro, NC 28659
Phone (336) 903-0147

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

1200 N Martin Luther King Jr Dr
Winston Salem, NC 27101
Phone (336) 713-9800

Interoperability endpoints

  • Direct secure messaging: jellison2755186@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 3

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 8

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": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1811251291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271572375",
            "telephone_number": "336-716-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "JIM",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-29",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "32955",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "2021-00081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.