Sean Frank Ellis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

825 Issued in WY

Practice address

1212 East 12TH Street
Casper, WY 82601-3910

Phone

(307) 265-8505

Fax

(307) 265-2005

NPI assigned

Jan 3, 2007

Last updated

Jul 8, 2007By 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

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Community Health Center of Central Wyoming Inc

  dba Community Health Center of Central Wyoming Inc Pediatrics

  • Federally Qualified Health Center (FQHC)
  • Lander, WY
  • NPI 1205308855

  Corporate Director

  CMS ownership
• Community Health Center of Central Wyoming Inc

  dba Community Health Center of Central Wyoming Inc Riverton

  • Federally Qualified Health Center (FQHC)
  • Riverton, WY
  • NPI 1275810160

  Corporate Director

  CMS ownership
• Community Health Center of Central Wyoming Inc

  dba Dubois Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Dubois, WY
  • NPI 1306136205

  Corporate Director

  CMS ownership
• Community Health Center of Central Wyoming, Inc.

  • Federally Qualified Health Center (FQHC)
  • Casper, WY
  • NPI 1447480561

  Corporate Director

  CMS ownership

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093872582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 EAST 12TH STREET",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826013910",
            "telephone_number": "307-265-8505",
            "fax_number": "307-265-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 EAST 12TH STREET",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826013910",
            "telephone_number": "307-265-8505",
            "fax_number": "307-265-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SEAN",
        "middle_name": "FRANK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WY",
            "license": "825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elkhorn Valley Rehabilitation Hospital LLC
• David Arnold Ellbogen, M.D.
• Roxanna R Elliott-Reno, R.N.
• Shelby Elliott
• Kaley Ellis, AU.D
• Amy Marie Elm, RN
• Tricia Elston, MA, CCC-SLP
• Julie Elvestad
• Embracing Change Counseling, LLC
• Emergency Medical Physicians PC

• Dentist in Casper, WY
• Providers in Casper, WY by specialty
• Dentist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.