Active NPI
Dale Edwin Ellis
- Physician Assistant
- Morganton, NC
National Provider Identifier
1932119435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 100890
- Practice address
- 1000 S Sterling St
Morganton, NC 28655 - Phone
- (828) 433-2235
- Fax
- (828) 433-2491
- NPI assigned
- Aug 8, 2006
- Last updated
- May 23, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 100890 | NC | Primary |
Addresses
Primary practice location
1000 S Sterling St
Morganton, NC 28655
Mailing address
304 Shady Rest Road
Morganton, NC 28655
Phone (828) 439-8506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100890 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369267200000",
"number": "1932119435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 SHADY REST ROAD",
"city": "MORGANTON",
"state": "NC",
"postal_code": "28655",
"telephone_number": "828-439-8506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 S STERLING ST",
"city": "MORGANTON",
"state": "NC",
"postal_code": "28655",
"telephone_number": "828-433-2235",
"fax_number": "828-433-2491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "DALE",
"middle_name": "EDWIN",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2013-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "100890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morganton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2013; 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.