Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacqueline Ellis

Individual provider Anesthesiology Physician · NPI 1629596085

Jacqueline Ellis is a Certified Registered Nurse Anesthetist (CRNA) in Grand Rapids, Michigan. Qualified in 2014, 12 years ago. Practices with Saint Mary's Health Services, a 177-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
12
Licensed in
MI
In the registry since
2017
Specialties on file
2
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Practice location Address checks out

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone: (616) 364-4200
Fax: (616) 364-7347
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 100 Michigan St Ne, Grand Rapids, MI 49503-2560 — (616) 364-4200

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 4704360147 (MI)
Anesthesiology Physician Taxonomy 207L00000X · Licence 4704360147 (MI)

Record details

NPI number1629596085
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 6, 2017
Last updated in NPPESJanuary 4, 2023
Certification dateDecember 30, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Saint Mary'S Health Services — 177 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Grand Rapids