Bryan Ellertson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

89635601205 Issued in UT

Practice address

2121 N 1700 W
Layton, UT 84041-8803

Phone

(801) 773-4840

Fax

(801) 525-8151

NPI assigned

Jun 15, 2011

Last updated

Dec 8, 2015By the provider in NPPES

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

Enrolled in UT

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: bryan.ellertson.p1@direct.tannerclinic.nextgenshare.com

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.

• Tanner Memorial Clinic

  • Internal Medicine Physician
  • Layton, UT
  • NPI 1447239355

  Pediatrics

  Medicare reassignment NPD
• Tanner Memorial Clinic

  dba Tanner Clinic Layton South

  • Multi-Specialty Clinic/Center
  • Layton, UT
  • NPI 1538951165
  NPD

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449532800000",
    "number": "1881989143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 337",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840410337",
            "telephone_number": "801-773-4840",
            "fax_number": "801-525-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 N 1700 W",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840418803",
            "telephone_number": "801-773-4840",
            "fax_number": "801-525-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERTSON",
        "first_name": "BRYAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-15",
        "last_updated": "2015-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "89635601205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elevate PT PLLC
• Elevated Health and Wellness LLC
• Stephanie Eley
• Stefanie Azevedo Elias, DPT
• Amy Ellefsen
• Staci Leann Elliott
• Rowan Ellis
• Carissa Annette Ellsworth, PHYSICIAN ASSISTANT
• Patricia Ellsworth, DNP
• Abigail Elmer

• Pediatrics Physician in Layton, UT
• Providers in Layton, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; 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.