1. Home
  2. Directory
  3. Ohio
  4. Fairborn
  5. General Practice
  6. NPI Profile

COLETTE MARK ELLIS MD
NPI 1629530225
General Practice in Fairborn, OH

Active since April 02, 2019PECOS Enrolled
81.6/100
CMS Quality Rating
1059 BAYWOOD DR, FAIRBORN, OH 45324(713) 339-0341 Get Directions Write a Review

NPPES record last updated: July 27, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 27, 2022, Jan 11, 2021, Nov 16, 2020 and 1 more (4 updates tracked since 2019).

About Colette Mark Ellis Md NPPES

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

COLETTE MARK ELLIS MD (NPI 1629530225) is an individual general practice provider in Fairborn, Ohio, licensed in Texas (S8030) and active in the NPI registry since April 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1629530225
Entity TypeIndividualFemale
Primary Taxonomy208D00000X
Provider Legal NameCOLETTE MARK ELLISCredential: MD
Location Address1059 BAYWOOD DRFairborn, OH 45324-2647
Mailing Address1059 Baywood DrFairborn, OH 45324-2647 · (713) 339-0341
Phone(713) 339-0341
Sole ProprietorNo
Enumeration DateApril 2, 2019
Last NPPES UpdateJuly 27, 20224 updates tracked since enumeration
NPPES CertifiedJuly 27, 2022
✔ NPI 1629530225 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in TX · S8030
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedSurgeryTaxonomy 208600000X · License S8030 (TX)
1059 BAYWOOD DR, Fairborn, OH 45324
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Colette Mark 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 Reassignments

2

Medicare enrollment records show Colette Ellis reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Vohra Post Acute Care Physicians Of Texas, PLLC
854 mi
Family Medicine
17218 PRESTON RD STE 2000
Dallas, TX 75252
  • Reassigned Medicare billing, Texas enrollment
  • 107 clinicians in this Medicare group
NPI 1821424789 (877) 866-7123
Robert Marriott Medical Corp
854 mi
Surgery
711 MATADOR LN
Mesquite, TX 75149
  • Reassigned Medicare billing, Texas enrollment
  • 46 clinicians in this Medicare group
NPI 1164973012 (877) 878-3289

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

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

81.6/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality75.44
Promoting Interoperability100
Improvement Activities40
Cost29.89

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Collagen dressing, sterile, size 16 sq. in. or less, each A6021
DME-Medical/Surgical Supplies · category DA023N
2 suppliers13 claims445 services$20.55 avg. paid by Medicare
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing A6196
DME-Medical/Surgical Supplies · category DA023N
2 suppliers17 claims548 services$7.19 avg. paid by Medicare
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing A6219
DME-Medical/Surgical Supplies · category DA023N
1 supplier22 claims748 services$0.93 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Colette Ellis's NPI number?

The NPI number for Colette Ellis is 1629530225. It was assigned to this individual provider in the NPPES registry on April 2, 2019.

Where is Colette Ellis located?

Colette Ellis practices at 1059 Baywood Dr, Fairborn, OH 45324. The listed phone number is (713) 339-0341.

What is Colette Ellis's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Colette Ellis enrolled in Medicare?

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

Which organizations bill Medicare for Colette Ellis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Colette Ellis reassigns Medicare benefits to 2 organizations: Vohra Post Acute Care Physicians Of Texas, PLLC (Dallas, TX) and Robert Marriott Medical Corp (Mesquite, TX). Each 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 Colette 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 Colette Ellis was last updated on July 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.