Shannon M Ellis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-09344 Issued in NC

Practice address

200 Pavilion Way
Southern Pines, NC 28387-4561

Phone

(910) 235-3204

NPI assigned

Aug 26, 2019

Last updated

Sep 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pinehurst Medical Clinic IncGroup PAC ID 5991617169, 162 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Unc Hospitals Hospital, Chapel Hill, NC, CCN 340061

Merit-based Incentive Payment System (MIPS)

Final score

67.12 of 100Reported as individual

Quality

52.22

Promoting interoperability

78

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ellis@pinehurstderm.emadirect.md
• Direct secure messaging: smellis@aadermaffiliates.emadirect.md
• Direct secure messaging: smellis@ncderm.emadirect.md

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.

• Pinehurst Medical Clinic, Inc.

  • Internal Medicine Physician
  • Pinehurst, NC
  • NPI 1255388369
  Medicare reassignment Care Compare group NPD
• Southern Dermatology, P.a.

  • Specialist
  • Raleigh, NC
  • NPI 1568415586
  Medicare reassignment
• Pinehurst Medical Clinic, Inc.

  dba PMC Reference Lab

  • Clinical Medical Laboratory
  • Southern Pines, NC
  • NPI 1962509372
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University of North Carolina Hospitals at Chapel Hill

  dba UNC Hospitals

  • General Acute Care Hospital
  • Chapel Hill, NC
  • NPI 1932208576
  Care Compare affiliation

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1841848678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PAVILION WAY",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PAVILION WAY",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874561",
            "telephone_number": "910-235-3204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Fox Hollow Rd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Pinehurst",
            "state": "NC",
            "postal_code": "283748593",
            "country_code": "US",
            "telephone_number": "910-295-7546",
            "fax_number": "910-692-2831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SHANNON",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-26",
        "last_updated": "2023-09-27",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-09344",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "001009344",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eckerd Corporation (Rite Aid Pharmacy 11517)
• Edc Drug Stores (Rite Aid Pharmacy 11518)
• Effective Interventions (Step Forward ABA)
• Osemwegie Eghidemwivbie, LMBT, AAS, PT
• Melton Stonewall Ellerbe, LCAS
• Janice K Ellstrom, CRNA
• Helena M Eng, CRNA
• Rosemary Eppell, PTA
• Rebecca Estes, MD
• Nicole Marie Eteo, CPNP

• Physician Assistant in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.