Active NPI
Douglas R Ellis, MD
- Family Medicine Physician
- Monticello, IL
National Provider Identifier
1992790786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-081822
- Practice address
- 1002 Medical Center Dr
Family Medicine
Monticello, IL 61856-2116 - Phone
- (217) 762-2518
- Fax
- (217) 762-5261
- NPI assigned
- Sep 17, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-081822 | IL | Primary |
Addresses
Primary practice location
1002 Medical Center Dr
Family Medicine
Monticello, IL 61856-2116
Mailing address
PO Box 6002
Urbana, IL 61803-6002
Phone (217) 326-8630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-081822 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366761600000",
"number": "1992790786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6002",
"city": "URBANA",
"state": "IL",
"postal_code": "618036002",
"telephone_number": "217-326-8630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1002 MEDICAL CENTER DR",
"address_2": "FAMILY MEDICINE",
"city": "MONTICELLO",
"state": "IL",
"postal_code": "618562116",
"telephone_number": "217-762-2518",
"fax_number": "217-762-5261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "DOUGLAS",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-17",
"last_updated": "2013-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036-081822",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.