Shawn Archie Ellis, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

4704362684 Issued in MI

Practice address

1780 E Parnall Rd
Jackson, MI 49201-7136

Phone

(517) 780-6357

NPI assigned

Mar 10, 2025

Last updated

Mar 10, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 MI

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 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hurley Medical CenterGroup PAC ID 2961308481, shared by 10 NPIs, 336 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hurley Medical Center Hospital, Flint, MI, CCN 230132

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Hurley Medical Center

  dba Hurley Nurse Practioner Group

  • Nurse Practitioner
  • Flint, MI
  • NPI 1053347880
  Medicare reassignment NPD
• Hurley Medical Center

  dba Hurley OB/GYN Research & Education

  • Obstetrics & Gynecology Physician
  • Flint, MI
  • NPI 1982630844
  Medicare reassignment NPD
• Hurley Medical Center

  dba Hurley Surgery Research & Education

  • Surgery Physician
  • Flint, MI
  • NPI 1659323384
  NPD
• Hurley Medical Center

  • Plastic and Reconstructive Surgery Physician
  • Flint, MI
  • NPI 1689345761
  NPD
• Numa P. Cabrera M.D.

  • Adult Mental Health Clinic/Center
  • Jackson, MI
  • NPI 1376732081
  NPD (past)

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

• Hurley Medical Center

  • General Acute Care Hospital
  • Flint, MI
  • NPI 1598717480
  Care Compare affiliation

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

{
    "created_epoch": "1741564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1932908431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1780 E PARNALL RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492017136",
            "telephone_number": "517-780-6357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 E PARNALL RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492017136",
            "telephone_number": "517-780-6357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SHAWN",
        "middle_name": "ARCHIE",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-03-10",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704362684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth J. Rutledge, DDS, PLC (Springcrest Dental Associates)
• Kiana Elliott
• Tiffany Elliott, LLMSW
• Diana Hwei-Ann Jan Ellis, D.D.S.
• Jolene Ellis, M.D.
• Kylie Ellsworth
• Ayman Elmadawy, DDS
• Elmortada Medical Services PC
• Sami Elsayed
• Ihab Elsewisy, RPH

• Acute Care Nurse Practitioner in Jackson, MI
• Providers in Jackson, MI by specialty
• Acute Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.