Charles Ellis

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C05576 Issued in MD

Practice address

1675 Woodbrooke Dr
Salisbury, MD 21804-8502

Phone

(410) 749-4154

Fax

(410) 860-9583

NPI assigned

Oct 27, 2014

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

Other names 1

• Charles Gabriel Ellis Other name

Medicare fee-for-service enrollment

Enrolled in MD, DE2 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

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tidalhealth Specialty Care LLCGroup PAC ID 7113340845, 375 clinicians

Peninsula Orthopaedic Assoc PAGroup PAC ID 6406844406, 56 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beebe Medical Center Hospital, Lewes, DE, CCN 080007
• Tidalhealth Peninsula Regional, Inc Hospital, Salisbury, MD, CCN 210019
• Atlantic General Hospital Hospital, Berlin, MD, CCN 210061
• Tidalhealth Nanticoke, Inc. Hospital, Seaford, DE, CCN 080006

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Tidalhealth Specialty Care, LLC

  • Medical Specialty Clinic/Center
  • Salisbury, MD
  • NPI 1619504735

  DE

  Medicare reassignment Care Compare group
• Peninsula Orthopaedic Assoc., PA

  • Orthopaedic Surgery Physician
  • Seaford, DE
  • NPI 1780814202
  Medicare reassignment Care Compare group
• Peninsula Orthopaedic Assoc, PA

  • Orthopaedic Surgery Physician
  • Salisbury, MD
  • NPI 1811188766

  Physician Assistant

  Medicare reassignment NPD
• Tidalhealth Peninsula Regional, Inc.

  • Family Medicine Physician
  • Salisbury, MD
  • NPI 1184832040

  Physician Assistant

  Medicare reassignment NPD
• Tidalhealth Peninsula Regional, Inc.

  • Community/Retail Pharmacy
  • Salisbury, MD
  • NPI 1871031559
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Tidalhealth Atlantic, Inc

  • General Acute Care Hospital
  • Berlin, MD
  • NPI 1053309120
  Care Compare affiliation
• Tidalhealth Peninsula Regional, Inc.

  • General Acute Care Hospital
  • Salisbury, MD
  • NPI 1780689463
  Care Compare affiliation
• Beebe Medical Center, Inc.

  • General Acute Care Hospital
  • Lewes, DE
  • NPI 1821196486
  Care Compare affiliation
• Tidalhealth Nanticoke, Inc

  • General Acute Care Hospital
  • Seaford, DE
  • NPI 1245214477
  Care Compare affiliation

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

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1922403450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69709",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212649709",
            "telephone_number": "410-749-4154",
            "fax_number": "410-860-9583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 WOODBROOKE DR",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218048502",
            "telephone_number": "410-749-4154",
            "fax_number": "410-860-9583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-27",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C05576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLES",
            "last_name": "ELLIS",
            "middle_name": "GABRIEL",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brittany Joy Elbourn, BA
• Elizabeth Pernal, M.D., P.a.
• Kerri V Ellinger, P.A.-C.
• Kathy June Elliott, ATC
• Valerie Elliott
• Derrick Norman Ellis, BS
• Mohamed Elnadi, DDS
• Emberly Care, LLC
• Kelly Ann Embert, BA
• Pamela Emenuga, DNP, CNM, WHNP

• Physician Assistant in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; 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.