Wladislaw V Ellis, M.D.

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

A24351 Issued in CA

Practice address

13847 Mallory CT
Grass Valley, CA 95949

Phone

(510) 849-4703

Fax

(530) 477-6092

NPI assigned

Jul 5, 2005

Last updated

Nov 16, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Interventional Pain Management

Education

University of California, Geffen School of Medicine, 1970

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542326400000",
    "number": "1992702039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13847 MALLORY CT",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959497658",
            "telephone_number": "510-849-4703",
            "fax_number": "530-477-6092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13847 MALLORY CT",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "95949",
            "telephone_number": "510-849-4703",
            "fax_number": "530-477-6092"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1220 Oxford St",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947091423",
            "country_code": "US",
            "telephone_number": "510-849-4703",
            "fax_number": "510-849-4995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "WLADISLAW",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2018-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "A24351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Eiermann
• Noura Mohamed Ibrahim Elebiary
• Kimberly A Elliott, FNP
• Robert Andrew Elliott
• Kathy Jean Ellis, LMFT
• Elwood Paul Reid MD Inc
• Sean Ely
• Emery & Ivey Physical Therapy
• Jack L Emery, PT
• Emq Children & Family Services

• Interventional Pain Medicine Physician in Grass Valley, CA
• Providers in Grass Valley, CA by specialty
• Interventional Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; 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.