DR. DUSTIN CLAY ELLIS (NPI# 1962658989) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962658989 |
| Entity Type | Individual |
| Full Name | DR. DUSTIN CLAY ELLIS |
| Credential | M.D. |
| Practice Address |
2186 N Hospital Blvd Ste 2 Sullivan IN 47882-7654 |
| Mailing Address |
Po Box 230 2229 Mary Sherman Drive Sullivan IN 47882-0230 |
| Practice Telephone | 8122683318 |
| Mailing Telephone | (812) 268-3318 |
| Mailing Fax Number | 8122684017 |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 11013685A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200015680A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2229 Mary Sherman Dr, Sullivan, IN 478827633 | 8122683318 | 8122684017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306002860 | Dustin Smith Ellis | Case Manager/Care Coordinator | 500 Wilson Pike Cir, Suite 320, Brentwood, TN 37027-5252 | 2008-08-04 |
| Street Address |
2186 N HOSPITAL BLVD STE 2 |
| City | SULLIVAN |
| State | IN |
| Zip Code | 47882-7654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568628915 | Barbara Ann Reed | Family Medicine | 2186 N Hospital Blvd Ste 2, Sullivan, IN 47882-7654 | 2008-08-05 |
| 1093323701 | Sullivan County Community Hospital | Clinic/Center | 2186 N Hospital Blvd Ste 2, Sullivan, IN 47882-7654 | 2020-07-20 |
| 1497363303 | Sullivan County Community Hospital | Family Medicine | 2186 N Hospital Blvd Ste 2, Sullivan, IN 47882-7654 | 2020-07-16 |
| 1770823387 | Kathleen Pirtle | Nurse Practitioner | 2186 N Hospital Blvd Ste 2, Sullivan, IN 47882-7654 | 2013-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659718336 | Neil Lynn Smith | Dentist | 118 S. Court St., Sullivan, IN 47882 | 2013-06-04 |
| 1184888000 | Mary Sherman Hospital | Hospice Care, Community Based | 817 North Section Street, Suite A, Sullivan, IN 47882 | 2008-07-10 |
| 1003838194 | Johnson Memorial Hospital | Durable Medical Equipment & Medical Supplies | 505 West Wolfe Street, Sullivan, IN 47882 | 2006-07-24 |
| 1255580593 | Daniel Choyce Callahan | Psychiatry & Neurology | 2204 N Section St, Sullivan, IN 47882 | 2008-09-11 |
| 1851394175 | Van Evanoff Jr. | Pain Medicine | 2204 N Section St, Suite B, Sullivan, IN 47882-0010 | 2005-05-31 |
| 1982780748 | Associated Physicians & Surgeons Clinic, LLC | Obstetrics & Gynecology | 2204 N Section St, Suite B, Sullivan, IN 47882-0010 | 2006-10-27 |
| 1871996199 | Sullivan Family Dentistry, LLC | Dentist | 2186 N Hospital Blvd., Suite 1, Sullivan, IN 47882-0468 | 2014-10-01 |
| 1487828455 | Kortni Reann Martindale | Speech-Language Pathologist | 368 W Indiana Ave, Sullivan, IN 47882-1117 | 2008-04-21 |
| 1831280585 | Southwest School Corporation | Local Education Agency (LEA) | 110 N Main St, Sullivan, IN 47882-1225 | 2006-09-27 |
| 1780717637 | Brian K Grindstaff | Chiropractor | 210 N Section St Unit C, Sullivan, IN 47882-1237 | 2007-03-13 |
| Find all providers in zip 47882 | ||||
| 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 |
|---|---|---|---|---|
| 1568628915 | Barbara Ann Reed | Family Medicine | 2186 N Hospital Blvd Ste 2, Sullivan, IN 47882-7654 | 2008-08-05 |
| 1922295815 | Patients First Health Care LLC | Family Medicine | 102 Grande Ctr, Sullivan, MO 63080-1266 | 2007-09-25 |
| 1548337942 | Premier Health Center, L.L.C. | Family Medicine | 102 Progress Pkwy, Sullivan, MO 63080-2359 | 2006-11-29 |
| 1578633194 | Mary Ann Chavez | Family Medicine | 1120 N Section St, Sullivan Medical Clinic, Sullivan, IN 47882-9200 | 2006-11-09 |
| 1912924630 | Medical Income Management Corp | Family Medicine | 101 W Jefferson St, Sullivan, IL 61951-1914 | 2006-07-17 |
| 1457393712 | Matthew J Tiefenbrunn | Family Medicine | 1326 S Service Rd W Ste 10, Sullivan, MO 63080-2306 | 2006-06-12 |
| 1811973944 | Yasuo Ishida | Family Medicine | 102 Progress Pkwy # A, Sullivan, MO 63080-2359 | 2005-12-20 |
| 1477555738 | Glen E Dust | Family Medicine | 2 W Adams St, Sullivan, IL 61951-1943 | 2005-06-01 |
| 1952304123 | Carl F. Conwell | Family Medicine | 2229 Mary Sherman Dr, Sullivan, IN 47882-7633 | 2005-05-23 |
| 1497363303 | Sullivan County Community Hospital | Family Medicine | 2186 N Hospital Blvd Ste 2, Sullivan, IN 47882-7654 | 2020-07-16 |
| Find all providers in SULLIVAN | ||||
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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.