Stephanie M Ellis, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

4909 N Glen Park Place Rd
Peoria, IL 61614-4676

Phone

(309) 674-7546

Fax

(309) 282-0500

NPI assigned

Aug 11, 2010

Sex

Female

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 IL, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Midwestern University, Chicago College of Osteopathic Med, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jason B. Amato, MD Dermatology, LLCGroup PAC ID 7214189687, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.8 of 100Reported as group

Quality

81.6

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Jason B. Amato, MD Dermatology, LLC

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1962751115
  Medicare reassignment Care Compare group
• Metro East Dermatology & Skin Cancer Center LLC

  • Dermatology Physician
  • Shiloh, IL
  • NPI 1518494996
  Medicare reassignment
• Soderstrom Dermatology Center S C

  • Dermatology Physician
  • Peoria, IL
  • NPI 1710931670
  Medicare reassignment
• Skin Cancer Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • O'Fallon, IL
  • NPI 1699407643
  NPD (past)

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281484800000",
    "number": "1922313238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546",
            "fax_number": "309-282-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546",
            "fax_number": "309-282-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "STEPHANIE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isaac Elkins, DO
• Katherine Ellingson, AG-ACNP-BC
• Linda Marie Elliott, PTA
• Catherine A Ellis, LCSW
• Hannah Claire Ellis
• Anna Ellison
• Emily Ellison
• Jean Michel Elsasser, PA-C
• Rebecca Elschlager, ATC
• Luke Elsener

• Physician Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; 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.