Individual provider Active NPI

Craig M Ellison, MD

  • Gastroenterology Physician
  • Alexandria, VA
National Provider Identifier
1932254083
Registry record updated Jan 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
0101234566 Issued in VA
Practice address
4660 Kenmore Ave
Suite #305
Alexandria, VA 22304-1313
Phone
(703) 751-5763
Fax
(703) 370-8704
NPI assigned
Jan 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 0101234566 VA Primary

Addresses

Primary practice location

4660 Kenmore Ave
Suite #305
Alexandria, VA 22304-1313

Mailing address

PO Box 17334
Baltimore, MD 21297-1334
Phone (703) 443-6717

Other identifiers 2

IdentifierTypeStateIssuer
P00777103OtherDCRR MEDICARE
1932254083MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050810001086 DC Practitioner - Gastroenterology 3870522733 Reassigns benefits to 2 organizations
I20160628000274 VA Practitioner - Gastroenterology 3870522733 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
George Washington University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Loudoun Medical Group, PCGroup PAC ID 0042119661, 272 clinicians
Gastroenterology Associates of Northern Virginia, LLCGroup PAC ID 1759371008, 98 clinicians

Practice addresses (Care Compare)

19450 Deerfield Ave
Suite 375
Leesburg, VA 20176-6822
Phone (571) 789-1846

4660 Kenmore Ave
Alexandria, VA 22304-1306

6355 Walker LN
308 Metropolitan ENT
Alexandria, VA 22310-3247
Phone (703) 313-7700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.65 of 100Reported as apm
Quality
85.31
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy132
Upper gastrointestinal (GI) endoscopy for acid reflux62

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Gastroenterology Associates of Northern Virginia, LLC Gastroenterology CurrentSince Apr 1, 2026 Accepting new patients
Loudoun Medical Group, PC CurrentSince Aug 1, 2009 Accepting new patients
Loudoun Medical Group, PC CurrentSince Aug 1, 2009 Accepting new patients
Loudoun Medical Group, PC Current Accepting new patients
Old Dominion Anesthesia LLC Past Accepting new patients
Gi Endoscopy Center of Northern Virginia Past Accepting new patients

Locations

4660 Kenmore Ave
Ste 305
Alexandria, VA 22304
Phone (703) 751-5763

5249 Duke St
Ste 100
Alexandria, VA 22304
Phone (703) 370-2814

4660 Kenmore Ave
Ste 500
Alexandria, VA 22304
Phone (703) 370-0073

6355 Walker Ln
Ste 308
Alexandria, VA 22310
Phone (703) 313-7700

4660 Kenmore Ave
Ste 400
Alexandria, VA 22304
Phone (703) 370-2457

4660 Kenmore Ave
Ste 100
Alexandria, VA 22304
Phone (703) 370-0400

20955 Professional Plz
Ste 200
Ashburn, VA 20147
Phone (703) 729-7652

3022 Williams Dr
Ste 301
Fairfax, VA 22031
Phone (703) 698-1775

224D Cornwall St NW
Ste 403
Leesburg, VA 20176
Phone (703) 737-6001

19450 Deerfield Ave
Ste 375
Leesburg, VA 20176
Phone (571) 789-1846

24570 Medical Dr
Sterling, VA 20166
Phone (571) 367-4400

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1932254083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17334",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212971334",
            "telephone_number": "703-443-6717",
            "fax_number": "703-443-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 KENMORE AVE",
            "address_2": "SUITE #305",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223041313",
            "telephone_number": "703-751-5763",
            "fax_number": "703-370-8704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "CRAIG",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "VA",
            "license": "0101234566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00777103",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932254083",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

Verify at the official NPI Registry.