NPIMap

Individual provider Active NPI

John Blaise Ellery III, MD

  • Family Medicine Physician
  • Sequim, WA
National Provider Identifier
1962039511
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD61439050 Issued in WA
Practice address
808 N 5TH Ave
Sequim, WA 98382-3045
Phone
(360) 683-5900
Fax
(360) 582-4800
NPI assigned
Mar 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD61439050 WA Primary

Addresses

Primary practice location

808 N 5TH Ave
Sequim, WA 98382-3045

Mailing address

808 N 5TH Ave
Sequim, WA 98382-3045
Phone (360) 683-5900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230817002345 WA Practitioner - Family Practice 3870915333 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Carolina at Chapel Hill School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jamestown S'Klallam TribeGroup PAC ID 2365349495, 38 clinicians

Practice addresses (Care Compare)

808 N 5TH Ave
Sequim, WA 98382-3045
Phone (360) 683-5900

Hospital & facility affiliations

  • Olympic Medical Home Health Home health agency, Port Angeles, WA, CCN 507072
  • Olympic Medical Center Hospital, Port Angeles, WA, CCN 500072
  • St Michael Medical Center Hospital, Silverdale, WA, CCN 500039
  • Jefferson Healthcare Hospital, Port Townsend, WA, CCN 501323
  • Forks Community Hospital Hospital, Forks, WA, CCN 501325

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61439050WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jamestown S'Klallam Tribe Family Medicine CurrentSince Oct 2, 2023 Accepting new patients
Jamestown S'Klallam Tribe Family Medicine CurrentSince Oct 2, 2023 Accepting new patients

Locations

808 N 5th Ave
Sequim, WA 98382
Phone (360) 582-4840

526 S 9th Ave
Sequim, WA 98382
Phone (360) 681-7755

Organizations & group practices 5

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 7

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": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1962039511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 N 5TH AVE",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983823045",
            "telephone_number": "360-683-5900",
            "fax_number": "360-582-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 N 5TH AVE",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983823045",
            "telephone_number": "360-683-5900",
            "fax_number": "360-582-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERY",
        "first_name": "JOHN",
        "middle_name": "BLAISE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61439050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sequim, WA

Sources for this page

Verify at the official NPI Registry.