NPIMap

Individual provider Active NPI

Mark Ellis, DPM

  • Foot & Ankle Surgery Podiatrist
  • Globe, AZ
National Provider Identifier
1972897080
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
0821 Issued in AZ
Practice address
5880 S Hospital Dr
Globe, AZ 85501-9447
Phone
(928) 425-3246
NPI assigned
Jun 6, 2011
Last updated
Jun 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Public Medicine Podiatrist 213EP0504X 10105797-0501 UT
Radiology Podiatrist 213ER0200X 10105797-0501 UT
Sports Medicine Podiatrist 213ES0000X 10105797-0501 UT
Foot & Ankle Surgery Podiatrist 213ES0103X 10105797-0501 UT
Foot & Ankle Surgery Podiatrist 213ES0103X 0821 AZ Primary

Addresses

Primary practice location

5880 S Hospital Dr
Globe, AZ 85501-9447

Mailing address

5994 S Hospital Dr
Globe, AZ 85501-9462

Other practice location 1

12592 S 150 E
Draper, UT 84020-8611
Phone (713) 377-2167

Other identifiers 1

IdentifierTypeStateIssuer
367438MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171116000146 TX Practitioner - Podiatry 5294957320 Reassigns benefits to 2 organizations
I20180615002417 AZ Practitioner - Podiatry 5294957320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

103 Medicine Way Rd
Peridot, AZ 85542-0787
Phone (928) 475-1400

5880 S Hospital Dr
Globe, AZ 85501-9447
Phone (928) 425-3247

P O Box
Suite 787
Peridot, AZ 85542-0787

PO Box
Suite 787
Peridot, AZ 85542-0787

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue68
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
10105797-0501UTMDPublic Medicine Podiatrist
0821AZMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation CurrentSince Oct 7, 2017 Accepting new patients
San Carlos Apache Healthcare Corporation CurrentSince Apr 15, 2019 Accepting new patients
San Carlos Apache Healthcare Corporation CurrentSince Apr 15, 2019 Accepting new patients
Cobre Valley Regional Medical Center CurrentSince Jun 25, 2018 Accepting new patients
Tuba City Regional Health Care Corporation Current Accepting new patients
Cobre Valley Regional Medical Center CurrentSince Jun 25, 2018 Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Oct 7, 2017 Accepting new patients
Cobre Valley Regional Medical Center Current Accepting new patients
Cobre Valley Regional Medical Center Past Accepting new patients
Brenderlin Health LLC Foot & Ankle Surgery Past Accepting new patients

Locations

5880 S Hospital Dr
Globe, AZ 85501
Phone (928) 402-1217

5990 S Hospital Dr
Globe, AZ 85501
Phone (520) 402-9319

5994 S Hospital Dr
Globe, AZ 85501
Phone (928) 425-7108

103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200

1134 W US Highway 60
Superior, AZ 85173
Phone (520) 689-2423

Organizations & group practices 10

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.

Hospital & facility affiliations 5

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": "1307318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1972897080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5994 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5880 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019447",
            "telephone_number": "928-425-3246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12592 S 150 E",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840208611",
            "country_code": "US",
            "telephone_number": "713-377-2167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-06",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP0504X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Public Medicine",
            "state": "UT",
            "license": "10105797-0501",
            "primary": false
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Radiology",
            "state": "UT",
            "license": "10105797-0501",
            "primary": false
        },
        {
            "code": "213ES0000X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Sports Medicine",
            "state": "UT",
            "license": "10105797-0501",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "UT",
            "license": "10105797-0501",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "0821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "367438",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Globe, AZ

Sources for this page

Verify at the official NPI Registry.