Active NPI
Eliza Caguioa Ellsworth, DPT
- Physical Therapist
- Bethel, AK
National Provider Identifier
1013274620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 103069
- Practice address
- 700 Chief Eddie Hoffman Hwy
Bethel, AK 99559 - Phone
- (907) 543-6342
- Fax
- (907) 543-6580
- NPI assigned
- Apr 19, 2012
- Last updated
- Aug 4, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 103069 | AK | Primary |
Addresses
Primary practice location
700 Chief Eddie Hoffman Hwy
Bethel, AK 99559
Mailing address
PO Box 3427
Bethel, AK 99559-3427
Phone (907) 543-6452
Other practice location 1
7000 Chief Eddie Hoffman Hwy
Bethel, AL 99559
Phone (907) 543-6342
Other practice location 2
2475 Boardwalk
Norman, OK 73069-6332
Phone (405) 447-1991
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200436060A | Medicaid | OK |
Other names 1
- Eliza Nicolas Caguioa
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4413 | OK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659571200000",
"number": "1013274620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3427",
"city": "BETHEL",
"state": "AK",
"postal_code": "995593427",
"telephone_number": "907-543-6452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 CHIEF EDDIE HOFFMAN HWY",
"city": "BETHEL",
"state": "AK",
"postal_code": "99559",
"telephone_number": "907-543-6342",
"fax_number": "907-543-6580"
}
],
"practiceLocations": [
{
"address_1": "7000 Chief Eddie Hoffman Hwy",
"address_purpose": "LOCATION",
"city": "Bethel",
"state": "AL",
"postal_code": "99559",
"country_code": "US",
"telephone_number": "907-543-6342",
"fax_number": "907-543-6580",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2475 Boardwalk",
"address_purpose": "LOCATION",
"city": "Norman",
"state": "OK",
"postal_code": "730696332",
"country_code": "US",
"telephone_number": "405-447-1991",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELLSWORTH",
"first_name": "ELIZA",
"middle_name": "CAGUIOA",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-19",
"last_updated": "2022-08-04",
"certification_date": "2022-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AK",
"license": "103069",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200436060A",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ELIZA",
"last_name": "CAGUIOA",
"middle_name": "NICOLAS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.