Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1255424214 Individual Practitioner Female Practitioner

Dr. Diana Hwei-Ann Jan Ellis , DDS

Dentist - General Practice • Jackson, MI

Professional Overview & Biography Verified Profile Summary

Dr. Diana Ellis, DDS is a registered healthcare professional specializing in Dentist - General Practice in Jackson, MI. Practice services are available at 500 N JACKSON ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

500 N Jackson St

Jackson, MI 492011223

Telephone 5177485500
Fax 5177809286
Associated Practice Facility / Clinic
🏢 Center For Family Health Facility NPI 1588722300

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Jackson, MI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 15.8 Yrs
Regional Practice Density
45 Specialists

Practicing in Jackson, MI (4360 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 DJ018840

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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
744718389 (MI)
Commercial Insurance / Payer ID Bcbs Provider Number
D801057 (MI)
Commercial Insurance / Payer ID Delta Dental Provider Num
88131 (MI)

Practice Associates & Co-Workers

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

40 Associated Practitioners
Kassidy Treacey

Nurse Practitioner - Family

NPI 1003603481
Dr. Raul Andino , MD

Obstetrics & Gynecology

NPI 1033121652

Doctor of Medicine (M.D.)

Dr. Gregory Naylor , MD

Internal Medicine

NPI 1083602742

Doctor of Medicine (M.D.)

Beth Vansumeren

Community Health Worker

NPI 1093541369
NPI 1093860413

Doctor of Dental Surgery

Kylie Young , LLMSW

Social Worker - Clinical

NPI 1104420942

Limited Licensed Master Social Worker

Career & Practice History Timeline

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

11 Historical Events
NPI Profile Active June 26, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location June 26, 2017

Registered at 500 N JACKSON ST, JACKSON, MI 492011223 (Tel: 5177485500)

📍
Updated Business Mailing Address June 26, 2017

Registered at 505 N JACKSON ST, JACKSON, MI 492011266 (Tel: (517) 748-5500)

👤
Provider Name / Credentials Updated June 26, 2017

Recorded as DIANA ELLIS, D.D.S.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 26, 2017

Dentist (License #DJ018840 in MI)

NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 989 W WASHINGTON ST, SUITE 104, MARQUETTE, MI 498554064 (Tel: 9062269992)

📍
Updated Business Mailing Address July 09, 2007

Registered at 989 W WASHINGTON ST, SUITE 104, MARQUETTE, MI 498554064 (Tel: 9062269992)

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as DIANA ELLIS, D.D.S.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Dentist (License #DJ018840 in MI)

🟢
Initial NPI Registration & Enumeration October 02, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1255424214
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 02, 2006
Last Update: July 21, 2022
Sole Proprietor: No

Mailing Address

505 N Jackson St

Jackson, MI 492011266

Phone: 5177485500

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.