JACQUELINE ELLIS
NPI 1629596085
Nurse Anesthetist, Certified Registered in Grand Rapids, MI

Q: What is Jacqueline Ellis's NPI number?

The NPI number for Jacqueline Ellis is 1629596085. It was assigned to this individual provider in the NPPES registry on September 6, 2017.

Q: What is Jacqueline Ellis's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Q: When was this NPI record last updated?

The NPPES record for Jacqueline Ellis was last updated on January 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since September 06, 2017Accepts Medicare Assignment

89.01/100

CMS Quality Rating

3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525(616) 364-4200(616) 364-7347 Get Directions Write a Review

NPPES record last updated: January 4, 2023. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Jan 4, 2023, Nov 3, 2021, Apr 27, 2021 (3 updates tracked since 2021).

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About Jacqueline Ellis NPPES

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

JACQUELINE ELLIS (NPI 1629596085) is an individual nurse anesthetist, certified registered in Grand Rapids, Michigan, licensed in Michigan (4704360147) and active in the NPI registry since September 2017. She is affiliated with Mercy Health Saint Mary's, maintains a secondary practice location in Grand Rapids, and is a graduate of Other (2014).

NPPES Registry Identity

NPI1629596085

Entity TypeIndividualFemale

Primary Taxonomy367500000X

Provider Legal NameJACQUELINE ELLIS

Location Address3333 EVERGREEN DR NEGrand Rapids, MI 49525-9493

Mailing Address3333 Evergreen Dr NeGrand Rapids, MI 49525-9493 · (616) 364-4200 · Fax (616) 364-7347

Phone(616) 364-4200

Fax(616) 364-7347

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateSeptember 6, 2017

Last NPPES UpdateJanuary 4, 20233 updates tracked since enumeration

NPPES CertifiedDecember 30, 2022

✔ NPI 1629596085 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367500000X

License✔ Licensed in MI · 4704360147

Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.

Also ListedAnesthesiologyTaxonomy 207L00000X · License 4704360147 (MI)

3333 EVERGREEN DR NE, Grand Rapids, MI 49525

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Secondary Practice Location 1

Location 1100 Michigan St NEGrand Rapids, MI 49503-2560 · Phone (616) 364-4200 · Fax (616) 364-7347

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacqueline Ellis is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4284023169

PECOS Enrollment IDI20211115002125

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mercy Health Saint Mary's

Acute Care Hospitals · Grand Rapids, MI

4/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number230059

Location200 Jefferson Avenue SEGrand Rapids, MI 49503 · Kent County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49525 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

$126.15 typical visit price

range $54.34 – $166.68

Typical copayment $31.53 (range $13.58 – $41.67)

Most-billed visit code 99204

Established Patient

$68.07 typical visit price

range $17.09 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

89.01/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

94.05

Improvement Activities

Cost

74.56

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.

MR. JEFFREY RYAN HALL AA

Anesthesiologist Assistant