Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1235289992 Deactivated / Inactive NPI Male Practitioner

Dr. Mark Ellis , DDS

Dentist - General Practice • Hines, IL

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Mark Ellis has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date January 12, 2007
NPI Deactivation Date November 29, 2017
Total Practice Duration ~10 Years of Practice (2007 – 2017)

Professional Overview & Biography Verified Profile Summary

Dr. Mark Ellis, DDS was a registered Dentist - General Practice practicing in Hines, IL. Throughout an active medical career spanning 10 years, Dr. Ellis provided care at the practice location at 5000 S 5TH AVE until profile deactivation on 2017-11-29.

Practice Location & Contact Primary Location

Practice Address

5000 S 5th Ave

Hines, IL 601413030

Telephone 2488954610
Associated Practice Facility / Clinic
🏢 Hines Vamc Facility NPI 1396793378

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Hines, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
5 Specialists

Practicing in Hines, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MI 706212

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
NPI 1003407420

Certified Athletic Trainer, RKT

Dr. Jamie Mathews , PsyD

Psychologist - Clinical

NPI 1013257153

Doctor of Psychology (Psy.D.)

Catherine Mazzuca , MSW, LCSW

Social Worker - Clinical

NPI 1013302538

Master of Social Work, Licensed Clinical Social Worker

Dr. Kathleen Colangelo , PhD

Psychologist - Clinical

NPI 1013391002

Doctor of Philosophy (Ph.D.)

Dr. Iulia Gambro , PhD

Psychologist - Clinical

NPI 1013576875

Doctor of Philosophy (Ph.D.)

Rachel Gill

Recreation Therapist

NPI 1013775980

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
⚠️
NPI Profile Deactivated November 29, 2017

Record deactivated on November 29, 2017

NPI Profile Active November 22, 2011

NPI status registered as active in NPPES database

📍
Updated Practice Location November 22, 2011

Registered at 5000 S 5TH AVE, HINES, IL 601413030 (Tel: 2488954610)

📍
Updated Business Mailing Address November 22, 2011

Registered at PO BOX 84, HINES, IL 601410084

👤
Provider Name / Credentials Updated November 22, 2011

Recorded as MARK ELLIS, D.D.S.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 22, 2011

Dentist (License #706212 in MI)

🟢
Initial NPI Registration & Enumeration January 12, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Dr. Mark Ellis. Be the first to share your experience!

Sign in to leave a review for Dr. Mark Ellis

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1235289992
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 12, 2007
Last Update: November 22, 2011
Deactivation Date: November 29, 2017

Mailing Address

Po Box 84

Hines, IL 601410084

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.