David Garth Ellertson Sr., M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

G17987 Issued in CA

Practice address

4101 Tully Rd
Suite 101
Modesto, CA 95356-8980

Phone

(209) 524-8346

Fax

(209) 524-7723

NPI assigned

Apr 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Practice roles

Locations

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.

• Valley Wound Healing Center, Inc.

  • Clinic/Center
  • Modesto, CA
  • NPI 1730285073
  Medicare reassignment NPD
• Western Associates in Surgery

  • Cardiovascular Disease Physician
  • Modesto, CA
  • NPI 1720292733
  NPD Authorized official

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423699200000",
    "number": "1912964495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 TULLY RD",
            "address_2": "SUITE 101",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568980",
            "telephone_number": "209-524-8346",
            "fax_number": "209-524-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 TULLY RD",
            "address_2": "SUITE 101",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568980",
            "telephone_number": "209-524-8346",
            "fax_number": "209-524-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERTSON",
        "first_name": "DAVID",
        "middle_name": "GARTH",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2015-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "G17987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "20014578",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vivian Elizondo
• Skylar Elkington
• Tamara Lynn Elkins, PH.D.
• Roberta Margaret Elledge, LMFT
• Ashley Renee Ellenberger, NP
• John Stephen Ellington, LCSW
• Alexis Elliott, BCBA
• Garrett William Elliott, OD
• Cody Ellis
• Desti A. Ellis, LCSW, CAS

• Vascular Surgery Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.