Gregory W Ellis, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

178505-1205 Issued in UT

Practice address

7050 South Highland Drive
Suite 230
Cottonwood Heights, UT 84121

Phone

(801) 878-4081

Fax

(801) 432-4264

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

No

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

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.

Opted out of Medicare

Yes, effective May 4, 2016 through May 4, 2028

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Ellis Psychiatric Healthcare LLC

  • Psychiatry Physician
  • Cottonwood Heights, UT
  • NPI 1134018492
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339632000000",
    "number": "1881768802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71312",
            "city": "SALT LAKE",
            "state": "UT",
            "postal_code": "841710312",
            "telephone_number": "801-878-4081",
            "fax_number": "801-432-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7050 SOUTH HIGHLAND DRIVE",
            "address_2": "SUITE 230",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "84121",
            "telephone_number": "801-878-4081",
            "fax_number": "801-432-4264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "GREGORY",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2012-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "178505-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ginger Ekberg
• David J Elliott
• Rhonda Elliott, OTR
• Ellis Psychiatric Healthcare LLC
• Deborah Marie Ellis, CNM APRN
• Kiryssa Ellisor
• Rachel Elsmore
• Sara Eltiste
• Emdr and Counseling Center PLLC
• Tristin Endicott, PA-C

• Psychiatry Physician in Cottonwood Heights, UT
• Providers in Cottonwood Heights, UT by specialty
• Psychiatry Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.