Ellen Fan M D P a

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

K8897 Issued in TX

Legal business name

ELLEN FAN M D P A

Practice address

2620 Communications Pkwy
Attn Dr. Fan
Plano, TX 75093-8800

Phone

(972) 769-8572

Fax

(972) 769-8591

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

Ellen Fan, M.D.NPI 1134153646

Title

Physician

Phone

(972) 769-8572

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Ellen Fan M D P a

  • Geriatric Psychiatry Physician
  • Dallas, TX
  • NPI 1467890178

  O20050512001017

  Same enrollment

Locations

Practitioners 1

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

• Ellen Fan, M.D.

  • Geriatric Psychiatry Physician
  • Plano, TX
  • NPI 1134153646
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392336000000",
    "number": "1982742276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 PRESTON RD",
            "address_2": "SUITE 350 BOX 242",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750937453",
            "telephone_number": "972-769-8572",
            "fax_number": "972-769-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 COMMUNICATIONS PKWY",
            "address_2": "ATTN DR. FAN",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938800",
            "telephone_number": "972-769-8572",
            "fax_number": "972-769-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN FAN M D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2014-02-14",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "972-769-8572",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "TX",
            "license": "K8897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179654201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Kerner, M.D., P.a.
• Mark Elizondo, LCSW
• Ahmed Elkaialy, MD
• Lisa McGillvary Elkin
• Amyra Elkins
• John Ellett, LPO
• Ellevecrown LLC
• Shaji Joseph Ellimuttil, PA
• Roseanne P Elling, PH.D
• David Bryan Elliott, LCSW

• Geriatric Psychiatry Physician in Plano, TX
• Providers in Plano, TX by specialty
• Geriatric Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.