Dale Samuel Ellis, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A40971 Issued in CA

Practice address

18582 Beach Blvd
Suite 23a
Huntington Beach, CA 92648-2000

Phone

(714) 964-4448

NPI assigned

Apr 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Family Care Medical Ass

  dba Cheshire Medical Corp

  • Occupational Medicine Physician
  • Huntington Beach, CA
  • NPI 1962540682
  NPD (past)

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841254141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 AVENUE OF THE ARTS",
            "address_2": "J422",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926262338",
            "telephone_number": "714-444-9958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18582 BEACH BLVD",
            "address_2": "SUITE 23A",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926482000",
            "telephone_number": "714-964-4448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DALE",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A40971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elevated Health Inc
• Bassem Galal Elgohary, M.D.
• Elham Elle Farajian, DPM, Professional Corporation
• Elizabeth Logue Physical Therapy.Inc
• Thomas A Elliott, PHARM.D.
• Mary Ellis
• Rachel Ellis, PA-C, MHS
• Marie-Ange Thi Huyen Tran Ellison, L.AC
• Trisha Elloyan
• Amy L. Ellsworth, RD

• Internal Medicine Physician in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.