Active NPI
John J Ellis, MD
- Internal Medicine Physician
- Salida, CO
National Provider Identifier
1811974629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 24459
- Practice address
- 550 W Hwy 50
Salida, CO 81201-2238 - Phone
- (719) 530-2000
- Fax
- (719) 530-2055
- NPI assigned
- Dec 22, 2005
- Last updated
- Mar 4, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 24459 | CO | Primary |
Addresses
Primary practice location
550 W Hwy 50
Salida, CO 81201-2238
Mailing address
PO Box 549
Salida, CO 81201-0549
Phone (719) 530-2000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62584251 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24459 | CO | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236124800000",
"number": "1811974629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 549",
"city": "SALIDA",
"state": "CO",
"postal_code": "812010549",
"telephone_number": "719-530-2000",
"fax_number": "719-530-2055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 W HWY 50",
"city": "SALIDA",
"state": "CO",
"postal_code": "812012238",
"telephone_number": "719-530-2000",
"fax_number": "719-530-2055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JOHN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2009-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CO",
"license": "24459",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "62584251",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salida, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.