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KATHLEEN DUNLEVY ELLIS PA-C
NPI 1891570545
Physician Assistant - Surgical in Mishawaka, IN

Active since August 30, 2023PECOS EnrolledAccepts Medicare Assignment
611 E DOUGLAS RD STE 207, MISHAWAKA, IN 46545(574) 335-6850 Get Directions Write a Review

NPPES record last updated: January 13, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 13, 2026, May 19, 2025, Oct 3, 2023 and 1 more (4 updates tracked since 2023).

About Kathleen Dunlevy Ellis Pa-c NPPES

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

KATHLEEN DUNLEVY ELLIS PA-C (NPI 1891570545) is an individual surgical provider in Mishawaka, Indiana, licensed in Indiana (10004107A) and active in the NPI registry since August 2023. She is enrolled in Medicare PECOS, is affiliated with Saint Joseph Regional Medical Center, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1891570545
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameKATHLEEN DUNLEVY ELLISCredential: PA-C
Location Address611 E DOUGLAS RD STE 207Mishawaka, IN 46545-1465
Mailing Address5215 Holy Cross PkwyMishawaka, IN 46545-1469 · (574) 335-8707 · Fax (574) 335-0741
Phone(574) 335-6850
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateAugust 30, 2023
Last NPPES UpdateJanuary 13, 20264 updates tracked since enumeration
NPPES CertifiedJanuary 13, 2026
✔ NPI 1891570545 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in IN · 10004107A
611 E DOUGLAS RD STE 207, Mishawaka, IN 46545
Open in Google Maps ↗

Other Identifiers 1

Medicaid300080410IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.Insurance ›

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

Kathleen Dunlevy Ellis Pa-c 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 ID5890140701
PECOS Enrollment IDI20231012003358
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.

Hospital Affiliations CMS Care Compare 2

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

Saint Joseph Regional Medical Center

Acute Care Hospitals · Mishawaka, IN
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150012
Location5215 Holy Cross PkwyMishawaka, IN 46545 · St. Joseph County
Emergency services Birthing friendly

Saint Joseph Regional Medical Center - Plymouth

Acute Care Hospitals · Plymouth, IN
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number150076
Location1915 Lake AvePlymouth, IN 46563 · Marshall County
Emergency services

Other Providers at the Same Location NPPES 4

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

DR. SUSHRUTA SHANTANU NAGARKATTI M.B.B.S.
Surgery (Surgical Oncology)
611 E DOUGLAS RD STE 207
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6850
MRS. DIANA E PEREZ - SOLANO PA-C
Physician Assistant
611 E DOUGLAS RD STE 207
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6850
DR. ERIC DAVID KNAPP D.O.
Surgery
611 E DOUGLAS RD STE 207
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6850
MATTHEW K FOLSTEIN MD
Surgery
611 E DOUGLAS RD STE 207
MISHAWAKA, IN 46545
St. Joseph County (574) 335-6850

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 Kathleen Ellis's NPI number?

The NPI number for Kathleen Ellis is 1891570545. It was assigned to this individual provider in the NPPES registry on August 30, 2023.

Where is Kathleen Ellis located?

Kathleen Ellis practices at 611 E Douglas Rd Ste 207, Mishawaka, IN 46545. The listed phone number is (574) 335-6850.

What is Kathleen Ellis's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Kathleen Ellis enrolled in Medicare?

Yes. Kathleen Ellis is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kathleen Ellis accept?

Health plans from CareSource list Kathleen Ellis as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kathleen Ellis affiliated with any hospitals?

According to CMS data, Kathleen Ellis is affiliated with Saint Joseph Regional Medical Center and Saint Joseph Regional Medical Center - Plymouth.

When was this NPI record last updated?

The NPPES record for Kathleen Ellis was last updated on January 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months 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.