Logan William Ellis

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

200 Patewood Dr Ste C300
Greenville, SC 29615-6324

Phone

(864) 908-0122

NPI assigned

Jan 4, 2021

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spartanburg Medical CenterGroup PAC ID 3072425297, 1,060 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pelham Medical Center Hospital, Greer, SC, CCN 420103

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Spartanburg Medical Center

  • Surgery Physician
  • Greer, SC
  • NPI 1760114664
  Medicare reassignment Care Compare group
• Spartanburg Medical Center

  • Surgery Physician
  • Greer, SC
  • NPI 1598111353
  NPD
• Spartanburg Medical Center

  • Physical Medicine & Rehabilitation Physician
  • Spartanburg, SC
  • NPI 1942188875
  NPD
• Spartanburg Medical Center

  • Obstetrics & Gynecology Physician
  • Spartanburg, SC
  • NPI 1376580852
  NPD (past)

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

• Pelham Medical Center

  • Pain Medicine Physician
  • Greer, SC
  • NPI 1942960844

  Hospital

  Care Compare affiliation
• Pelham Medical Center

  • General Acute Care Hospital
  • Greer, SC
  • NPI 1982800397
  Care Compare affiliation

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1952999294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "803-434-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR STE C300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156324",
            "telephone_number": "864-908-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "LOGAN",
        "middle_name": "WILLIAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-04",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1175810",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaime Elyse Elliotte, APRN
• Brittany Pirko Ellis, RN, MSN, FNP-C
• Grace Marie Ellis, OT
• James Madison Ellis, MD
• Kristin Jennifer Ellis, OTR/L
• Madison Miranda Ellis
• William Ellis, MD
• Shawn Gray Ellison, PHYSICAL THERAPIST
• Katherine Laura Ellsworth
• Donald Keith Elmore, DC

• Physician Assistant in Greenville, SC
• Providers in Greenville, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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.