Active NPI
Sandra L Ellis, MD
- Internal Medicine Physician
- Brandon, FL
National Provider Identifier
1861419491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME125071
- Practice address
- 214 Morrison Rd Ste 110
Brandon, FL 33511-4849 - Phone
- (813) 844-4300
- Fax
- (813) 844-1909
- NPI assigned
- Jul 17, 2006
- Last updated
- Jun 8, 2021
- Sex
- Female
- 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 | ME125071 | FL | Primary |
Addresses
Primary practice location
214 Morrison Rd Ste 110
Brandon, FL 33511-4849
Mailing address
PO Box 1289
Tampa, FL 33601-1289
Phone (813) 844-4300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104077793 | Medicaid | MI | |
| 383454949 | Other | MI | TAX ID |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sellis107659@direct.tgh.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
214 Morrison Rd
Suite 110
Brandon, FL 33511-4849
Phone (813) 844-4300
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tampa General Medical Group Inc | Current | Accepting new patients | |
| Tampa General Hospital | Current | Accepting new patients | |
| Tampa General Medical Group Inc | Current | Accepting new patients | |
| Tampa General Medical Group Inc | Current | Accepting new patients | |
| Tampa General Medical Group Inc | Past | Accepting new patients | |
| Sandra L Ellis MD PLLC | Internal Medicine | Past | Accepting new patients |
Locations
214 Morrison Rd
Ste 110
Brandon, FL 33511
Phone (800) 844-9302
409 Bayshore Blvd
Tampa, FL 33606
Phone (813) 253-2640
Interoperability endpoints
- https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
- sellis107659@direct.tgh.org
Organizations & group practices 6
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.
-
- Internal Medicine Physician
- Southfield, MI
- NPI 1205166337
-
- General Acute Care Hospital
- Tampa, FL
- NPI 1124558929
-
dba TGH Heart & Vascular Institute Sun City
- Cardiovascular Disease Physician
- Sun City Center, FL
- NPI 1144910316
-
dba TGMG Brandon
- Family Medicine Physician
- Brandon, FL
- NPI 1588901482
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Tampa General Hospital
- General Acute Care Hospital
- Tampa, FL
- NPI 1235196510
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623110400000",
"number": "1861419491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1289",
"city": "TAMPA",
"state": "FL",
"postal_code": "336011289",
"telephone_number": "813-844-4300",
"fax_number": "813-844-1909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 MORRISON RD STE 110",
"city": "BRANDON",
"state": "FL",
"postal_code": "335114849",
"telephone_number": "813-844-4300",
"fax_number": "813-844-1909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "SANDRA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2021-06-08",
"certification_date": "2021-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME125071",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104077793",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "383454949",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "sellis107659@direct.tgh.org",
"affiliation": "N",
"address_1": "214 Morrison Rd Ste 110",
"city": "Brandon",
"state": "FL",
"country_code": "US",
"postal_code": "335114849",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.