Clarence V Ellis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

33692 Issued in CO

Practice address

12790 W Alameda Pkwy Ste a
Lakewood, CO 80228-2850

Phone

(303) 403-6350

Fax

(303) 403-6372

NPI assigned

Jun 13, 2006

Last updated

Jan 25, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cellis6854@direct.intermountainhealth.org

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.

• Intermountain Front Range, Inc.

  dba Intermountain Lutheran Hospital - APC

  • Internal Medicine Physician
  • Wheat Ridge, CO
  • NPI 1083444079
  Medicare reassignment NPD
• Intermountain Medical Group Denver, LLC

  • Family Medicine Physician
  • Denver, CO
  • NPI 1083021083
  Medicare reassignment NPD
• Intermountain Front Range, Inc.

  dba Lutheran Hospital - Breast Care Center

  • General Acute Care Hospital
  • Wheat Ridge, CO
  • NPI 1619706249
  NPD
• Intermountain Front Range, Inc.

  dba Cancer Centers of Colorado - Lutheran Medical Center - Radiation Onc

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Wheat Ridge, CO
  • NPI 1649210188

  Family Medicine

  NPD
• Intermountain Medical Group Denver, LLC

  dba Orthopedic Centers of Colorado - Saint Joseph

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Denver, CO
  • NPI 1083598874
  NPD
• Intermountain Medical Group Denver, LLC

  dba Green Valley Ranch Clinic - Primary Care

  • Family Medicine Physician
  • Denver, CO
  • NPI 1760095939
  NPD

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327449600000",
    "number": "1982647475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 W 26TH AVE STE 400D",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802115357",
            "telephone_number": "303-988-4870",
            "fax_number": "303-984-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12790 W ALAMEDA PKWY STE A",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282850",
            "telephone_number": "303-403-6350",
            "fax_number": "303-403-6372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CLARENCE",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2012-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "33692",
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "CO",
            "license": "33692",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "0801103606",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61572578",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Elliott
• Daisha Elliott
• Jennifer Renee Elliott, RBT
• Mary B Elliott, RN
• Carrie L Ellis, LPC
• Dafne Itati Ellis, DMD MS
• Mechelle Renee Ellis, MA
• Tracy Ellis
• Donna Ruth Ellsworth, MSN, NP
• Greg Ellsworth, RN

• Family Medicine Physician in Lakewood, CO
• Providers in Lakewood, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.