Active NPI
Jordan Michael Ellis, PHD
- Clinical Psychologist
- JB Andrews, MD
National Provider Identifier
1972167161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810007310
- Practice address
- 1060 W Perimeter Rd
JB Andrews, MD 20762-6602 - Phone
- (240) 857-7186
- NPI assigned
- Apr 24, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Psychologist | 103TH0004X | |||
| Clinical Psychologist | 103TC0700X | 0810007310 | VA | Primary |
Addresses
Primary practice location
1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Mailing address
1100 Wilford Hall Loop
BLDG. 4554, 59 MDW/Gme, Jbsa Lackland
Jbsa Lackland, TX 78236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810007310 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750032000000",
"number": "1972167161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP",
"address_2": "BLDG. 4554, 59 MDW/GME, JBSA LACKLAND",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "78236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 W PERIMETER RD",
"city": "JB ANDREWS",
"state": "MD",
"postal_code": "207626602",
"telephone_number": "240-857-7186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JORDAN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-24",
"last_updated": "2025-06-16",
"certification_date": "2025-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810007310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in JB Andrews, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.