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DR. MARK GREGORY ELLIS MD
NPI 1003812744
Pediatrics in Eureka, CA

Active since June 27, 2005PECOS Enrolled
2200 TYDD ST, EUREKA, CA 95501(707) 269-7051(707) 269-7054 Get Directions Write a Review

NPPES record last updated: March 17, 2018. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 17, 2018, Mar 7, 2018, Dec 15, 2017 (3 updates tracked since 2017).

About Dr. Mark Gregory Ellis Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARK GREGORY ELLIS MD (NPI 1003812744) is an individual pediatrics provider in Eureka, California, licensed in California (G65432) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS and maintains a secondary practice location in Eureka.

NPPES Registry Identity

NPI1003812744
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameDR. MARK GREGORY ELLISCredential: MD
Location Address2200 TYDD STEureka, CA 95501-1284
Mailing Address670 9th St Ste 203Arcata, CA 95521-6249 · (707) 826-8633 · Fax (707) 826-8638
Phone(707) 269-7051
Fax(707) 269-7054
Sole ProprietorNo
Enumeration DateJune 27, 2005
Last NPPES UpdateMarch 17, 20183 updates tracked since enumeration
✔ NPI 1003812744 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · G65432
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
2200 TYDD ST, Eureka, CA 95501
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Secondary Practice Location 1

Location 12800 Harris StEureka, CA 95503-4809 · Phone (707) 445-8416 · Fax (707) 445-4182

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Mark Gregory Ellis Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mark Ellis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Open Door Community Health Centers
Same address
Federally Qualified Health Center (FQHC)
2200 TYDD ST
Eureka, CA 95501
  • Reassigned Medicare billing, California enrollment
  • 175 clinicians in this Medicare group
NPI 1669569109 (707) 441-1624

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95501 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.32 typical visit price
range $58.87 – $176.60
Typical copayment $22.58 (range $14.71 – $44.15)
Most-billed visit code 99203
Established Patient
$103.36 typical visit price
range $19.28 – $144.60
Typical copayment $25.84 (range $4.82 – $36.15)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. DEBBRA MELODY HAVEN PSYD PHD
Psychologist
2200 TYDD ST
EUREKA, CA 95501
Humboldt County (707) 441-1624
BRANDON EDWARD TOMLIN LCSW
Social Worker (Clinical)
2200 TYDD ST
EUREKA, CA 95501
Humboldt County (707) 441-1624
PENNY POWERS RN
Registered Nurse
2200 TYDD ST
EUREKA, CA 95501
Humboldt County (707) 441-1624
ANGELO JOHN ALFANO FNP
Nurse Practitioner (Family)
2200 TYDD ST
EUREKA, CA 95501
Humboldt County (707) 441-1624
MS. SUZANNE DIETZ PNP
Nurse Practitioner
2200 TYDD ST
EUREKA, CA 95501
Humboldt County (707) 269-7051
DR. PIPPA ELAYNE COULTER MD, PHD
Pediatrics
2200 TYDD ST
EUREKA, CA 95501
Humboldt County (707) 269-7051
CELESTE MAXINE SAYLES-CROY DO
Internal Medicine (Geriatric Medicine)
2200 TYDD ST
EUREKA, CA 95501
Humboldt County (707) 441-1624
LILIA SANDLER
Registered Nurse
2200 TYDD ST
EUREKA, CA 95501
Humboldt County (707) 441-1624

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Ellis's NPI number?

The NPI number for Mark Ellis is 1003812744. It was assigned to this individual provider in the NPPES registry on June 27, 2005.

Where is Mark Ellis located?

Mark Ellis practices at 2200 Tydd St, Eureka, CA 95501. The listed phone number is (707) 269-7051.

What is Mark Ellis's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Mark Ellis enrolled in Medicare?

Yes. Mark Ellis is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mark Ellis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mark Ellis reassigns Medicare benefits to Open Door Community Health Centers (Eureka, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mark Ellis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mark Ellis was last updated on March 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.