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MR. DAVID GARTH ELLERTSON M.D. NPI 1912964495


NPI Information

NPI: 1912964495
Provider Name: MR. DAVID GARTH ELLERTSON, M.D.
Classification: Surgery - 2086S0129X
Entity Type: Individual

Specialization: Vascular Surgery

PECOS Registration: Yes

Address:
4101 TULLY RD
SUITE 101
MODESTO, CA
ZIP 95356
Phone: (209) 524-8346
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MR. David Garth Ellertson, M.D. is a vascular surgery surgery in Modesto, CA with 56 years of experience. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. MR. David Garth Ellertson, M.D. NPI is 1912964495. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF CALIFORNIA, IRVINE, CALIFORNIA COLLEGE OF MEDICINE
Graduation Year:1968

The provider's business location address is:

4101 TULLY RD
SUITE 101
MODESTO, CA
ZIP 95356-980
Phone: (209) 524-8346
Fax: (209) 524-7723

The NPI 1912964495 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Management and supervision of oxygen chamber therapy per session (HCPCS:99183)
  • Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers (HCPCS:93970)
  • Ultrasound study of arteries and arterial grafts of both legs (HCPCS:93925)
  • Removal of tissue from wounds per session (HCPCS:97597)

The enumeration date for this NPI number is 4/27/2006 and was last updated on 2/12/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12086S0129XSurgeryVascular SurgeryG17987CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
120014578OTHERCALIFORNIAMEDICARE ID
200G179870MEDICARE PINCALIFORNIA
3A40243MEDICARE UPINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.