Individual provider Active NPI

Ellis J Salloum, M.D.

  • Vascular Surgery Physician
  • San Antonio, TX
National Provider Identifier
1871540088
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
V8531 Issued in TX
Practice address
8115 Datapoint Dr Ste 200
San Antonio, TX 78229-3745
Phone
(210) 615-6626
Fax
(210) 477-0279
NPI assigned
May 31, 2006
Last updated
Aug 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X V8531 TX
Vascular Surgery Physician 2086S0129X V8531 TX Primary

Addresses

Primary practice location

8115 Datapoint Dr Ste 200
San Antonio, TX 78229-3745

Mailing address

215 N San Saba Ste 301
San Antonio, TX 78207-3164
Phone (210) 615-6626

Other practice location 1

215 N San Saba Ste 201
San Antonio, TX 78207-3120
Phone (210) 547-3430

Other practice location 2

215 N San Saba Ste 206
San Antonio, TX 78207-3120
Phone (210) 615-6626

Other names 1

  • Dr. Ellis J Salloum Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, PA, TX3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20200409003698 WV Practitioner - Vascular Surgery 4486616810 Reassigns benefits to 1 organization
I20201221000098 PA Practitioner - Vascular Surgery 4486616810 Reassigns benefits to 1 organization
I20250606000722 TX Practitioner - Vascular Surgery 4486616810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Mississippi School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
M Reza Mizani MD PAGroup PAC ID 5294709689, 28 clinicians

Practice addresses (Care Compare)

8115 Datapoint Dr
Suite 200
San Antonio, TX 78229-3745
Phone (210) 614-7900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
V8531TXMDSurgery Physician
37431TNMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation CurrentSince Feb 9, 2020 Accepting new patients
M. Reza Mizani, M.D., P.a. Surgery CurrentSince Jun 6, 2025 Accepting new patients
West Virginia University Medical Corporation Surgery CurrentSince Sep 10, 2020 Accepting new patients
Wvu Med Corp Cheat Lake Physicians CurrentSince Feb 9, 2020 Accepting new patients
M. Reza Mizani, M.D., P.a. CurrentSince Jun 6, 2025 Accepting new patients
The Baxley and Appling County Hospital Authority Past Accepting new patients
Natchez Medical Foundation Inc. Vascular Surgery Past Accepting new patients
Wesley Physician Services LLC Past Accepting new patients
Natchez Regional Clinic Surgery Past Accepting new patients

Locations

251 N 4th St
Oakland, MD 21550
Phone (301) 533-4000

880 Memorial Dr
Lowr Level
Oakland, MD 21550
Phone (301) 334-1177

401 E Murphy Ave
Connellsville, PA 15425
Phone (724) 626-2343

451 Murtha Dr
Waynesburg, PA 15370
Phone (304) 598-4253

205 22nd St
Hondo, TX 78861
Phone (830) 426-2753

215 N San Saba
Ste 201
San Antonio, TX 78207
Phone (210) 547-3430

215 N San Saba
Ste 206
San Antonio, TX 78207
Phone (210) 477-3271

215 N San Saba
Ste 301
San Antonio, TX 78207
Phone (210) 212-8984

343 W Houston St
Ste 609
San Antonio, TX 78205
Phone (210) 212-4595

8115 Datapoint Dr
Ste 200
San Antonio, TX 78229

1 Amalia Dr
Buckhannon, WV 26201
Phone (304) 473-2185

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

1 Medical Park
Wheeling, WV 26003
Phone (304) 243-3124

Interoperability endpoints

  • Direct secure messaging: esalloum156837@direct.wvuhsdirect.com
  • FHIR API: https://api.platform.athenahealth.com/1930/brand/2/csg/102/fhir/r4

Organizations & group practices 9

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1871540088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N SAN SABA STE 301",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782073164",
            "telephone_number": "210-615-6626",
            "fax_number": "210-477-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8115 DATAPOINT DR STE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293745",
            "telephone_number": "210-615-6626",
            "fax_number": "210-477-0279"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 N San Saba Ste 201",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782073120",
            "country_code": "US",
            "telephone_number": "210-547-3430",
            "fax_number": "210-229-2626",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "215 N San Saba Ste 206",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782073120",
            "country_code": "US",
            "telephone_number": "210-615-6626",
            "fax_number": "210-477-0279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SALLOUM",
        "first_name": "ELLIS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "V8531",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "V8531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLIS",
            "last_name": "SALLOUM",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.