Ira Keith Ellis, MD
Individual provider Active NPI Addiction Medicine (Family Medicine) Physician · Milan, TN
NPI 1922005388 · NPPES record last updated Jan 10, 2024
Key facts
- NPI
- 1922005388
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction Medicine (Family Medicine) Physician 207QA0401X
- License
- 38294 (TN)
- Practice address
- 2084 W Main St
Milan, TN 38358-3515 - Phone
- (615) 673-6737
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Tennessee, HSC, College of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Impact Healthcare, PLLC
Practice addresses (Care Compare)
37 Sandstone Cir
Suite 92B
Jackson, TN 38305-2089
Phone (731) 265-6025
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040719001453 | TN | Practitioner - Family Practice |
5496734766 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impact Healthcare, PLLC | Addiction Medicine | Current |
Accepting new patients |
| Impact Healthcare, PLLC | Addiction Medicine | Current |
Accepting new patients |
| Physicians Quality Care PLLC | Current |
Accepting new patients | |
| Jackson Clinic PA | Past | Accepting new patients | |
| Bolivar General Hospital, Inc. | Past | Accepting new patients | |
| Bolivar General Hospital, Inc. | Past | Accepting new patients | |
| West Tennessee Medical Group Inc | Family Medicine | Past | Accepting new patients |
Locations
48 Medical Park Dr E
Ste 453
Birmingham, AL 35235
Phone (205) 517-7730
1000 Urban Center Dr
Ste 600
Vestavia, AL 35242
Phone (205) 208-0312
37 Sandstone Cir
Ste 92B
Jackson, TN 38305
Phone (731) 265-6025
2075 Pleasant Plains Ext Rd
#R
Jackson, TN 38305
Phone (731) 984-8400
37 Sandstone Cir
Ste 92
Jackson, TN 38305
Phone (731) 265-6025
1101 Fox Meadows Blvd
Ste 105
Sevierville, TN 37862
Phone (615) 382-3002
801 Hill St
Ste A
Springfield, TN 37172
Phone (615) 382-3002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 38294 | TN | |
| Addiction Medicine (Family Medicine) Physician | 207QA0401X | 38294 | TN | Yes |
Addresses
Primary practice location
2084 W Main St
Milan, TN 38358-3515
Mailing address
294 Summar Dr
Dept 289
Jackson, TN 38301-3915
Phone (731) 423-1932
Other practice location 1
73 White Bridge Rd # 103-243
Nashville, TN 37205-1444
Phone (731) 423-1932
Other practice location 2
3074 Creswell St
Milan, TN 38358-3500
Phone (615) 673-6737
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34018 | Other | TN | TLC |
| 626001636 | Other | TN | UNITED HEALTHCARE |
| 4101718 | Other | TN | BLUE CROSS BLUE SHIELD |
| 5657408 | Other | TN | CIGNA |
| 3823013 | Medicaid | TN | |
| 626001636 | Other | TN | USA MANAGED CARE |
| P00277818 | Other | TN | RAILROAD MEDICARE |
| 4124210 | Other | BCBS | |
| 626001636 | Other | TN | HEALTH PARTNERS |
| 166981 | Other | TN | UNISON |
| 3895527 | Medicaid | TN |
Other providers in Milan, TN
- Laura Duck
- Dynamix Physical Therapy LLC
- E.W. James & Sons
- Reagan Echtenkamp
- Clifford Lee Edwards Sr.
- Virginia Houston Emerson
- Carrie Esch
- Fabiola Escobar
- Family Dental Care of Milan
- Thomas Ferrell
All providers in Milan, TN · Addiction Medicine (Family Medicine) Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.