Dr Mark F Ellis Dpma Professional Medical Corporation

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

1670511 Issued in LA

Legal business name

DR MARK F ELLIS DPMA PROFESSIONAL MEDICAL CORPORATION

Practice address

913 S College Rd Ste 216B
Lafayette, LA 70503-3060

Phone

(337) 593-1278

Fax

(337) 593-1280

NPI assigned

Jun 1, 2006

Last updated

Aug 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Ellis, DPMNPI 1215975891

Title

Physician

Phone

(337) 593-1278

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Ellis, DPM

  • Foot Surgery Podiatrist
  • Lafayette, LA
  • NPI 1215975891

  Foot & Ankle Surgery

  Medicare reassignment NPD Authorized official
• Larrica Davis, FNP

  • Family Medicine Physician
  • Lafayette, LA
  • NPI 1821759697
  NPD

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1811934268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W SAINT MARY BLVD",
            "address_2": "STE 520",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705064600",
            "telephone_number": "337-593-1278",
            "fax_number": "337-593-1280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 S COLLEGE RD STE 216B",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033060",
            "telephone_number": "337-593-1278",
            "fax_number": "337-593-1280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MARK F ELLIS DPMA PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "337-593-1278",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "LA",
            "license": "1670511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1670511",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot Surgery Podiatrist in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Foot Surgery Podiatrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.