MEDICARE: JASON M ELLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	04734	IA
2	207Q00000X	Family Medicine Physician	R9584	IA
3	208M00000X	Hospitalist Physician	36174323	IL

General Provider Information

NPI Number	:	1679828578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M ELLIS

Provider Business Mailing Address
First Line	:	100 E LEFEVRE RD
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-1279
Country	:	US
Telephone Number	:	815-625-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E LEFEVRE RD
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-1279
Country	:	US
Telephone Number	:	815-625-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	04/14/2026

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Directions to “ JASON M ELLIS ” Practice Location

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