Robert Lynn Ellis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D3529 Issued in ID

Practice address

143 1/2 E Main
Rigby, ID 83442

Phone

(208) 745-0400

Fax

(208) 745-5005

NPI assigned

Aug 30, 2006

Last updated

Jun 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• West Wind Dental

  • General Practice Dentistry
  • Rigby, ID
  • NPI 1891478723
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1083724843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 E FREMONT AVE",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834421410",
            "telephone_number": "208-745-0400",
            "fax_number": "208-745-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 1/2 E MAIN",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "83442",
            "telephone_number": "208-745-0400",
            "fax_number": "208-745-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ROBERT",
        "middle_name": "LYNN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806083700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Dilworth, SLP
• Terri Dodge, CADC
• Preston Dryden, DMD
• East Idaho Ear Nose Throat-Facial Plastic Surgery PA (Richard Garrett Lee)
• Colby Douglas Edmonds
• Daniel Stephen Felix, LMFT
• Cameron T. French, PA-C
• Jessica K Fuggiti, AUD
• Lauren Christine Garcia, LM, CPM, NCMA
• Bryant Lee Gardner

• Dentist in Rigby, ID
• Providers in Rigby, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.