ANDREA M ELLIS (NPI# 1063661148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063661148 |
| Entity Type | Individual |
| Full Name | ANDREA M ELLIS |
| Credential | MD |
| Practice Address |
8288 S Broadway Ave Tyler TX 75703-5262 |
| Mailing Address |
Po Box 846098 Dallas TX 75284-6098 |
| Practice Telephone | 9036067060 |
| Mailing Telephone | 9033246450 |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2020-06-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | BP10032729 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS | 8CU926 | 01 |
| TX | TRICARE | 752616977118 | 01 |
| TX | 284827701 | 05 | |
| TX | TRICARE | 75-2616977-042 | 01 |
| TX | TRICARE | 752616977077 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 520 Douglas Blvd, Tyler, TX 757028307 | 9035931721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629472550 | Andrea Ellis | Nurse Practitioner | 3525 Augustus Road, Agape Physicians Care, Aiken, SC 29801 | 2014-10-21 |
| 1861723462 | Andrea Ellis | Social Worker | 14 Maine St # 54, Brunswick, ME 04011-2049 | 2010-01-21 |
| 1497925408 | Andrea Nicole Ellis | Chiropractor | 8140 Walnut Hill Ln Ste 120, Dallas, TX 75231-4464 | 2008-03-05 |
| 1164605812 | Andrea P Ellis | Registered Nurse | 9141 Stratus Cirlcle, N/a, Manlius, NY 13104-2143 | 2007-12-17 |
| 1922621051 | Andrea Ellis | Counselor | 1110 Benfield Blvd, Millersville, MD 21108-2639 | 2020-05-23 |
| 1770070898 | Andrea Loretta Ellis | Nurse Practitioner | 919 E 2nd St, Sanford, FL 32771 | 2018-04-14 |
| 1104267194 | Andrea Ellis | Case Manager/Care Coordinator | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2013-07-08 |
| 1699902775 | Andrea Ellis | Counselor | 1875 N Ridge Rd E, Lorain, OH 44055-3371 | 2009-06-16 |
| 1093953101 | Andrea Deno Ellis | Counselor | 21714 Hardy Oak, Suite # 100, San Antonio, TX 78258-4838 | 2009-01-27 |
| 1639340151 | Andrea Louise Ellis | Speech-Language Pathologist | 102 Smithfield St, Buckhannon, WV 26201-2620 | 2008-03-13 |
| Street Address |
8288 S BROADWAY AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75703-5262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376549246 | John Jason Page | Family Medicine | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2005-06-24 |
| 1427449529 | Sonja Faye Tiller | Nurse Practitioner | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2015-02-10 |
| 1669765350 | Mary Kathryn Eagleton | Pediatrics | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2011-05-27 |
| 1598993172 | Holly Akin Blanco | Pediatrics | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2009-06-23 |
| 1487893525 | Gale Jeannie Hobson | Family Medicine | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2009-02-12 |
| 1235275314 | Kurt Nielsen | Emergency Medicine | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2007-01-29 |
| 1194743278 | Roy Brent Wadle | Family Medicine | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2006-07-17 |
| 1750344966 | Kimberly Eakin Wegener | Internal Medicine | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2006-04-10 |
| 1003881608 | John W Scroggins | Family Medicine | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2006-02-17 |
| 1952373987 | Catherine Zilinskas Giordano | Pediatrics | 8288 S Broadway Ave, Tyler, TX 75703-5262 | 2006-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922632553 | Christina Kay Baker | Family Medicine | 2333 Dueling Oaks Dr, Tyler, TX 75703-0326 | 2020-02-21 |
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1396389870 | Shelly Lynn Williams | Family Medicine | 1420 W Southwest Loop 323 Ste 100, Tyler, TX 75701-9347 | 2019-10-29 |
| 1891354494 | Beverly Diann Butler | Family Medicine | 5604 Old Bullard Rd Ste 107, Tyler, TX 75703-4359 | 2019-06-07 |
| 1851846018 | Thomas Mason Worthington Jr. | Family Medicine | 9141 Chisholm Trl, Tyler, TX 75703-0409 | 2016-08-17 |
| 1881069557 | The Bradley Clinic of Texas, Pllc | Family Medicine | 1402 Rice Rd, Suite 100, Tyler, TX 75703-3260 | 2015-12-07 |
| 1750764189 | Diabetic Renewal Center LLC | Family Medicine | 1015 Pruitt Pl Ste 105, Tyler, TX 75703-1154 | 2015-07-02 |
| 1013306273 | Pure Radiance Laser Retreat | Family Medicine | 6722 S Broadway Ave, Tyler, TX 75703-4730 | 2015-01-12 |
| 1023412988 | James Kent Gray | Family Medicine | 14843 Big Oak Bay Rd, Tyler, TX 75707-7309 | 2014-10-21 |
| 1346640182 | Morris Mht LLC | Family Medicine | 2030 Stonegate Blvd, Tyler, TX 75703-0103 | 2014-08-29 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.