Bobby J Ellis
Internal Medicine

Address: 921 14th Ave Nw, Ardmore, OK 73401-1837
Phone: 5802235311

Bobby J Ellis (NPI# 1679595144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1679595144
Entity Type Individual
Full Name Bobby J Ellis
Credential M.D.
Gender Male
Practice Address 921 14th Ave Nw
Ardmore
OK 73401-1837
Practice Telephone 5802235311
Practice Fax Number 5802238227
Mailing Address 4401 W Memorial Rd
140
Oklahoma City
OK 73134-1785
Mailing Telephone 4057523162
Mailing Fax Number 4059365211
Sole Proprietor Yes, this individual is a Sole Proprietor
Enumeration Date 2006-07-24
Last Update Date 2014-04-29

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
No 207R00000X Internal Medicine Allopathic & Osteopathic Physicians 0417821 KS
Yes 207R00000X Internal Medicine Allopathic & Osteopathic Physicians 26021 OK

Other Provider Identifier

State Identifier Issuer Type Code
OK 200128140A MEDICAID

Physician Overview

NPI 1679595144
PAC ID by PECOS 2466417753
Professional Enrollment ID I20080401000912
Full Name Bobby J Ellis
Organization Legal Name MERCY CLINIC OKLAHOMA COMMUNITIES
Phone Number 5802235311
Gender M
Credential MD
Medical School UNIVERSITY OF KANSAS SCHOOL OF MEDICINE
Graduation Year 1980
Primary Specialty INTERNAL MEDICINE
Group Practice PAC ID 1153468921
Number of Group Practice Members 420
Accepts Medicare Assignment Y
Report Quality Measures Y
Use Electronic Health Records Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
370047 MERCY HOSPITAL ARDMORE, INC
370013 MERCY HOSPITAL OKLAHOMA CITY, INC
371310 MERCY HOSPITAL HEALDTON, INC.
371306 MERCY HEALTH LOVE COUNTY

Taxonomy Information

Taxonomy Code 207R00000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine

Taxonomy Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1386090066 Jody Lee Smith Internal Medicine 1011 14th Ave Nw, Ardmore, OK 73401-1828 2016-05-11
1578906657 Mercy Hospital Ardmore, Inc Internal Medicine 1101 14th Ave Nw, Ardmore, OK 73401-1830 2013-04-09
1467780940 Elyse Gail Seltzer Internal Medicine 128 Saint Georges Rd, Ardmore, PA 19003-2506 2009-11-23
1194053702 Newman M Yeilding IIi Internal Medicine 129 Edgewood Rd, Ardmore, PA 19003-2507 2009-11-20
1679603153 Jason Willis Internal Medicine 1101 12th Ave, Nw, Mercy Ardmore Hospital Wound Care Center, Ardmore, OK 73401 2007-03-06
1306985882 Bruce Stewart Gilmore Internal Medicine 1015 S Commerce St, Ardmore, OK 73401-5018 2007-02-05
1861432940 Steven Demetrius Saris Internal Medicine 130 Valley Rd, Ardmore, PA 19003-1511 2006-06-07
1215986559 A. Wayne Troncelliti Internal Medicine 1522 Wynnewood Rd, Ardmore, PA 19003-2719 2006-05-05
1811951999 Jeffery A Rother Internal Medicine 1221 G St Nw, Ardmore, OK 73401-1812 2006-04-14
1366404105 Brian Michael Shockey Internal Medicine 2419 Chickasaw Blvd, Ardmore, OK 73401-1466 2006-04-05
Find all providers in ARDMORE

Office Location

Street Address 921 14TH AVE NW
City ARDMORE
State OK
Zip Code 73401-1837

Providers in the same location

NPI Name Taxonomy Address Enumeration
1457331175 Medical Arts Clinic of Ardmore Inc Internal Medicine 921 14th Ave Nw, Ardmore, OK 73401-1837 2006-01-19
1912395898 Lisa Burton Nurse Practitioner 921 14th Ave Nw, Ardmore, OK 73401-1837 2014-12-31
1932448347 Jerad Scott Wagner Physician Assistant 921 14th Ave Nw, Ardmore, OK 73401-1837 2013-02-05
1376703595 Summer Kirby Family Medicine 921 14th Ave Nw, Ardmore, OK 73401-1837 2008-06-11
1487854642 Derek Todd Landis Pediatrics 921 14th Ave Nw, Ardmore, OK 73401-1837 2007-07-24
1205929320 Ashley V Kelley Internal Medicine 921 14th Ave Nw, Ardmore, OK 73401-1837 2006-10-02
1306889878 Sallie J Walker Nurse Practitioner 921 14th Ave Nw, Ardmore, OK 73401-1837 2006-06-13
1235176629 Wilfred S Gauthier Surgery 921 14th Ave Nw, Ardmore, OK 73401-1837 2006-06-02
1194779975 Toribio C Velasquez Internal Medicine 921 14th Ave Nw, Ardmore, OK 73401-1837 2006-05-19
1114982527 Mercy Health Services - Southern Oklahoma, LLC Clinic/Center 921 14th Ave Nw, Ardmore, OK 73401-1837 2006-04-19
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1487213302 Rachel Diane Wrany Nurse Practitioner Oklahoma Heart Hospital Physicians, LLC, 731 12th Avenue Nw, Suite 202, Ardmore, OK 73401 2019-06-13
1790349991 Shirley Denise Brown Licensed Psychiatric Technician 1219 Kst N.w, 1219 Kst N.w, Ardmore, OK 73401 2019-04-24
1427512359 Billy Joe Oshields Case Manager/Care Coordinator 6862 State Hwy 199 Ardmore Oklahoma, 6862 State Hwy 199, Ardmore, OK 73401 2019-01-24
1174007595 Tawnya Dawn Peery Nurse Practitioner 1108 W. Walnut Drive, Ardmore, OK 73401 2018-09-21
1679055016 Teresa Marie Hernandez Behavior Technician 1219 K St. Nw, Ardmore, OK 73401 2018-09-01
1063991974 Sawyer Rae Shamburger Occupational Therapy Assistant 208 North Praire St, Pilot Point, TX 73401 2018-08-10
1417473521 Chelsye Bacon Peer Specialist 905 Holiday Drive, Ardmore, OK 73401 2017-08-21
1003279746 Jeni Presley Marriage & Family Therapist Outpatient Services-ardmore; 2510 Chickasaw Dr., Strong Family Development;, Ardmore, OK 73401 2016-03-31
1982080909 Alison Hill Pharmacist 1111 N. Commerce, Ardmore, OK 73401 2015-07-31
1316346547 Olivia Larae Carrell Counselor 15 Monroe Street Ne, Ardmore, OK 73401 2014-08-13
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Competitor

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City ARDMORE
Zip Code 73401

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Dataset Information

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.

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