Stephanie Ellis, MSN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

7558496-4405 Issued in UT

Practice address

395 W Cougar Blvd Ste 104
Provo, UT 84604-3334

Phone

(801) 357-8200

Fax

(801) 357-8201

NPI assigned

Mar 11, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Utah Cancer Specialists PCGroup PAC ID 1355254749, 48 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

86.89 of 100Reported as group

Quality

77.34

Promoting interoperability

90

Improvement activities

40

Cost

77.57

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

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.

• Utah Cancer Specialists PC

  • Medical Oncology Physician
  • Salt Lake City, UT
  • NPI 1619925369
  Medicare reassignment Care Compare group NPD
• Hospital Corporation of Utah

  • Psychiatric Hospital Unit
  • Bountiful, UT
  • NPI 1497709471
  NPD (past)
• Utah Cancer Specialists PC

  • Non-Pharmacy Dispensing Site
  • Salt Lake City, UT
  • NPI 1912058942
  NPD (past)

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

{
    "created_epoch": "1646956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1942958673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 E 3900 S STE C230",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241297",
            "telephone_number": "801-262-9494",
            "fax_number": "866-415-6807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD STE 104",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043334",
            "telephone_number": "801-357-8200",
            "fax_number": "801-357-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "STEPHANIE",
        "credential": "MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-11",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "UT",
            "license": "7558496-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sellis@utahcancer.direct.varian.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "395 W Cougar Blvd Ste 104",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kaylene Ellertson, RN
• Alex Ellis
• Jesse Wren Ellis, LCSW
• Preston Chad Ellis, MS, DDS
• Sophia Ellis
• Summer Alyson Ellis
• Brynna Boettcher Ellison
• Charles Ellison
• Ellsworth Foot and Ankle
• Ellsworth Foot and Ankle Clinic

• Adult Health Nurse Practitioner in Provo, UT
• Providers in Provo, UT by specialty
• Adult Health Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; 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.