Ira Keith Ellis, MD

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

38294 Issued in TN

Practice address

2084 W Main St
Milan, TN 38358-3515

Phone

(615) 673-6737

NPI assigned

Jun 30, 2005

Last updated

Jan 10, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Family PracticeAlso: Addiction Medicine

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, PLLCGroup PAC ID 5991065427, 7 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Boyett Healthcare of Tennessee, PLLC

  dba Impact Healthcare LLC

  • Addiction Medicine (Family Medicine) Physician
  • Jackson, TN
  • NPI 1487185153
  Medicare reassignment Care Compare group NPD
• Impact Healthcare, PLLC

  • Internal Medicine Physician
  • Springfield, TN
  • NPI 1639656986

  Addiction Medicine

  NPD
• Physicians Quality Care PLLC

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1528240256
  NPD
• Bolivar General Hospital, Inc.

  dba Bolivar ER

  • General Acute Care Hospital
  • Bolivar, TN
  • NPI 1174545446
  NPD (past)
• Bolivar General Hospital, Inc.

  dba West Tennessee Healthcare Bolivar Hospital

  • Critical Access Hospital
  • Bolivar, TN
  • NPI 1518957950
  NPD (past)
• Jackson Clinic PA

  dba Jackson Clinc PA DME

  • Durable Medical Equipment & Medical Supplies
  • Jackson, TN
  • NPI 1689443038
  NPD (past)
• Physicians Quality Care PLLC

  • Rural Health Clinic/Center
  • Milan, TN
  • NPI 1821906173
  NPD (past)
• West Tennessee Medical Group Inc

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1053615955

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1922005388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "294 SUMMAR DR",
            "address_2": "DEPT 289",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013915",
            "telephone_number": "731-423-1932",
            "fax_number": "731-410-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2084 W MAIN ST",
            "city": "MILAN",
            "state": "TN",
            "postal_code": "383583515",
            "telephone_number": "615-673-6737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "73 White Bridge Rd # 103-243",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372051444",
            "country_code": "US",
            "telephone_number": "731-423-1932",
            "fax_number": "731-423-4919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3074 Creswell St",
            "address_purpose": "LOCATION",
            "city": "Milan",
            "state": "TN",
            "postal_code": "383583500",
            "country_code": "US",
            "telephone_number": "615-673-6737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "IRA",
        "middle_name": "KEITH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "38294",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "TN",
            "license": "38294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Duck
• Dynamix Physical Therapy LLC
• E.W. James & Sons (EW James Pharmacy 74)
• Reagan Echtenkamp
• Clifford Lee Edwards Sr.
• Virginia Houston Emerson, RPH
• Carrie Esch, PT
• Fabiola Escobar, PT
• Family Dental Care of Milan
• Thomas Ferrell, PTA

• Addiction Medicine (Family Medicine) Physician in Milan, TN
• Providers in Milan, TN by specialty
• Addiction Medicine (Family Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.