Jacqueline Ellis, - Medicare Certified Registered Nurse Anesthetist (crna) in Grand Rapids, MI

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Jacqueline Ellis, is a medicare enrolled "Nurse Anesthetist, Certified Registered" physician in Grand Rapids, Michigan. She graduated from medical school in 2014 and has 10 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). She is a member of the group practice West Michigan Anesthesia Pc, Saint Marys Health Services and her current practice location is 3333 Evergreen Dr Ne, Grand Rapids, Michigan. You can reach out to her office (for appointments etc.) via phone at (616) 364-4200.

Jacqueline Ellis is licensed to practice in Michigan (license number 4704360147) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1629596085.

Contact Information

Jacqueline Ellis,
3333 Evergreen Dr Ne,
Grand Rapids, MI 49525-9493
(616) 364-4200
(616) 364-7347

Map and Direction




Physician's Profile

Full NameJacqueline Ellis
GenderFemale
SpecialityCertified Registered Nurse Anesthetist (crna)
Experience10 Years
Location3333 Evergreen Dr Ne, Grand Rapids, Michigan
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Jacqueline Ellis graduated from medical school in 2014
  NPI Data:
  • NPI Number: 1629596085
  • Provider Enumeration Date: 09/06/2017
  • Last Update Date: 01/04/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 4284023169
  • Enrollment ID: I20211115002125

Medical Identifiers

Medical identifiers for Jacqueline Ellis such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1629596085NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207L00000XAnesthesiology 4704360147 (Michigan)Secondary
367500000XNurse Anesthetist, Certified Registered 4704360147 (Michigan)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Mercy Health Saint Mary'sGrand rapids, MIHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
West Michigan Anesthesia Pc1355243551193
Saint Marys Health Services4981500436163

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jacqueline Ellis allows following entities to bill medicare on her behalf.
Entity NameWest Michigan Anesthesia Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1225016926
PECOS PAC ID: 1355243551
Enrollment ID: O20040127000018
Entity NameSaint Marys Health Services
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1124063078
PECOS PAC ID: 4981500436
Enrollment ID: O20040329001233
Entity NameAnesthesia Medical Consultants, Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1063710689
PECOS PAC ID: 3678751658
Enrollment ID: O20110621000722

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacqueline Ellis is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jacqueline Ellis,
3333 Evergreen Dr Ne,
Grand Rapids, MI 49525-9493

Ph: (616) 364-4200		Jacqueline Ellis,
3333 Evergreen Dr Ne,
Grand Rapids, MI 49525-9493

Ph: (616) 364-4200

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.