Andrew James Ellis, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2018012696 Issued in MO

Practice address

1465 S Grand Blvd
Saint Louis, MO 63104-1003

Phone

(314) 577-5643

Fax

(314) 268-4019

NPI assigned

May 29, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aellis433913@direct-ehr-ssmhc.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mercy Hospitals East Communities

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1427098169
  Medicare reassignment NPD
• SSM Health Care Group

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1306589544

  Pediatrics

  Medicare reassignment NPD
• Mercy Hospitals East Communities

  • Land Ambulance
  • Saint Louis, MO
  • NPI 1881329902
  NPD
• SSM Health Care Group

  • Dermatopathology Physician
  • Saint Louis, MO
  • NPI 1932844495
  NPD
• St Louis Pathology Assoc Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Saint Louis, MO
  • NPI 1194778415
  NPD
• SSM Cardinal Glennon Children'S Hospital

  • Children's Hospital
  • Saint Louis, MO
  • NPI 1508935891
  NPD (past)

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1881006435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-5643",
            "fax_number": "314-268-4019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-5643",
            "fax_number": "314-268-4019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ANDREW",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-29",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01078376",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2018012696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "11017649A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Jane Elliott, DNP, APRN, FNP-C
• Ellis Dental LLC
• Ellis Sleep Center LLC
• Ellis Therapy & Consulting, LLC
• Alysa Gail Ellis, MD
• Carol A Ellis, RN
• Christine M Ellis, FNP
• Denise Michele Ellis, P.T.
• Holly Ellis, DDS
• Jabon L Ellis, D.O.

• Pediatrics Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.