Stephanie Ellis, CRNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

24866 Issued in AZ

Practice address

5102 W Campbell Ave
Phoenix, AZ 85031-1703

Phone

(602) 655-1000

NPI assigned

Aug 13, 2019

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

Enrolled in PA, AZ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

District Medical Group Inc 454 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.59 of 100Reported as group

Quality

81.55

Promoting interoperability

100

Improvement activities

40

Cost

79.5

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sellis222305@direct.valleywisehealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• District Medical Group, Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Phoenix, AZ
  • NPI 1336472448

  AZ

  Medicare reassignment Care Compare group NPD
• New Directions Mental Health, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • MC Murray, PA
  • NPI 1215904800

  PA

  Medicare reassignment NPD
• District Medical Group, Inc

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1144624339
  NPD
• District Medical Group, Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Phoenix, AZ
  • NPI 1992038004
  NPD
• District Medical Group, Inc

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1295968162
  NPD (past)
• Maricopa County Special Health Care District

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1073576740
  NPD (past)

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

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1992351209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850168034",
            "telephone_number": "602-470-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5102 W CAMPBELL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850311703",
            "telephone_number": "602-655-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1051 Country Club Rd",
            "address_purpose": "LOCATION",
            "city": "Monongahela",
            "state": "PA",
            "postal_code": "150631553",
            "country_code": "US",
            "telephone_number": "724-258-8014",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Jefferson Ave",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "PA",
            "postal_code": "153014119",
            "country_code": "US",
            "telephone_number": "724-222-6603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 Hidden Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Mc Murray",
            "state": "PA",
            "postal_code": "153172685",
            "country_code": "US",
            "telephone_number": "724-941-4070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "STEPHANIE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-13",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP020669",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "24866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha A Ellis, PA-C
• Maya Ellis
• Michelle Jeanette Ellis, LMFT
• Nora Denise Ellis, PAC
• Samantha Ellis, DNP
• Lauren Ellish, CCC-SLP
• Jeanette Leann Ellison, PMHNP-C
• Kimberlee Janette Despain Ellison, PT, DPT, C/NDT
• Sarah Ells
• Jordan Luke Ellstrom, PHARM.D.

• All providers in Phoenix, AZ
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; 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.
• 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.