Madeline Wood Ellis, PA
Physician Assistant, Medical in Peoria, AZ. Individual provider (NPI-1).
NPI number1568042935
StatusActive
Last updated in NPPESApr 29, 2025
Details
- NPI
- 1568042935
- Entity type
- Individual (NPI-1)
- Name
- Madeline Wood Ellis
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 10, 2021
- Certification date
- Apr 29, 2025
- Last updated
- Apr 29, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 8497 | AZ | Yes |
| 363AM0700X | Physician Assistant, Medical | PA61306757 | WA |
Practice location
21980 N 83rd AvePeoria, AZ 85383-1850
Phone 623-465-6375
Mailing address
21980 N 83rd AvePeoria, AZ 85383-1850
Phone 623-465-6375
Other practice locations
6323 S Rural Rd Ste 107
Tempe, AZ 85283-2933
Tempe, AZ 85283-2933
Phone 480-827-5630
201 16th Ave E
Seattle, WA 98112-5226
Seattle, WA 98112-5226
Phone 206-326-3000 · Fax 877-515-2975
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 35 Medical Physician Assistant providers in Peoria · All 3,876 providers in Peoria
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