JESSICA DANIELLE ELLIS — NPI 1245659705 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology in FLAT ROCK, NC)

CMS-1500 Box 24J / 33a • NPI

1245659705

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LG0600X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology

Box 32 Service Location & ZIP+4

571 S ALLEN RD, FLAT ROCK, NC, 28731-9447

✓ 9-Digit EDI 837 ZIP+4 (28731-9447)

Practice Phone & Referral Fax

(828) 692-6178

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1245659705 (JESSICA DANIELLE ELLIS) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1245659705` (NPI-1 Individual Practitioner)
Provider / Legal Name	JESSICA DANIELLE ELLIS
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology NUCC Code: `363LG0600X` (Nurse Practitioner, Gerontology)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	571 S ALLEN RD, FLAT ROCK, NC, 28731-9447
Practice Telephone / Fax	Tel: (828) 692-6178
Administrative Mailing Address	571 S ALLEN RD, FLAT ROCK, NC, 28731-9447
Enumeration & Last Sync	Enumerated: 2014-04-14 \| CMS Record Updated: 2022-08-17

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

571 S ALLEN RD, FLAT ROCK, NC, 28731-9447

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Plain-English Taxonomy & CMS Crosswalk (363LG0600X)

What Does Taxonomy Code 363LG0600X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LG0600X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Gerontology for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JESSICA DANIELLE ELLIS)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: NC \| License: `174165` \| Primary: Secondary
`363LG0600X` — Nurse Practitioner, Gerontology Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology	State: NC \| License: `174165` \| Primary: Yes (Primary)

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JESSICA DANIELLE ELLIS (NPI #1245659705)