Dr John P Ellis Clinic Podiatry LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

36002463E Issued in OH

Legal business name

DR JOHN P ELLIS CLINIC PODIATRY LLC

Practice address

21992 Lorain Rd
Fairview Park, OH 44126-3333

Phone

(440) 333-7300

Fax

(440) 235-8440

NPI assigned

Apr 21, 2008

Organization subpart

No

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

Authorized official

Name

John P Ellis, DPMNPI 1043384795

Title

President

Phone

(440) 333-7300

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John P Ellis, DPM

  • Podiatrist
  • Fairview Park, OH
  • NPI 1043384795
  Medicare reassignment NPD Authorized official
• John Mario Cuffari, DPM

  • Podiatrist
  • Fairview Park, OH
  • NPI 1407054885
  NPD (past)

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

{
    "created_epoch": "1208736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437436800000",
    "number": "1972777928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4758 RIDGE RD",
            "address_2": "STE 161",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441443327",
            "telephone_number": "440-235-8484",
            "fax_number": "440-235-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21992 LORAIN RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441263333",
            "telephone_number": "440-333-7300",
            "fax_number": "440-235-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JOHN P ELLIS CLINIC PODIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-21",
        "last_updated": "2015-07-21",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-333-7300",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36002463E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0691845",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Fairview Park, OH
• Providers in Fairview Park, OH by specialty
• Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.