Ellen Augustine Jacus, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10005023 Issued in WA

Practice address

77 N Main St
Coupeville, WA 98239-9556

Phone

(360) 678-4440

NPI assigned

Jun 9, 2006

Last updated

May 9, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Whidbey Island Internal Medicine

  • Internal Medicine Physician
  • Coupeville, WA
  • NPI 1003851338
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1972544336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746",
            "city": "COUPEVILLE",
            "state": "WA",
            "postal_code": "982390746",
            "telephone_number": "360-678-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 N MAIN ST",
            "city": "COUPEVILLE",
            "state": "WA",
            "postal_code": "982399556",
            "telephone_number": "360-678-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACUS",
        "first_name": "ELLEN",
        "middle_name": "AUGUSTINE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10005023",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10005023",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Island County Dermatology PLLC (Whidbey Dermatology)
• Island County Ultrasound
• Island Facial Aesthetics P.S.
• Island Prosthetics & Orthotics, Inc.
• J Chalice Bailey LMFT CCTP PLLC
• Rida Jamal, M.D.
• Janet E Colli PHD PLLC
• Kristine Liane Jarrell, AUD
• Stevette Javier, ARNP
• Arely Jimenez, LMFT

• Physician Assistant in Coupeville, WA
• Providers in Coupeville, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.