Active NPI
Ellis Knox List, D.D.S.
- General Practice Dentistry
- Durham, NC
National Provider Identifier
1114921764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5687
- Practice address
- 1014 Lamond Ave
Durham, NC 27701-2021 - Phone
- (919) 682-5327
- Fax
- (919) 688-4588
- NPI assigned
- Jun 10, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5687 | NC | Primary |
| General Practice Dentistry | 1223G0001X | 30-01-8657 | OH |
Addresses
Primary practice location
1014 Lamond Ave
Durham, NC 27701-2021
Mailing address
1014 Lamond Ave
Durham, NC 27701-2021
Phone (919) 682-5327
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27028-1 | Other | NC | BLUE CROSS/BLUE SHIELD # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 13, 2016 through Apr 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5687 | NC | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ellis K. List, D.D.S., P.a. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Durham, NC
- NPI 1821124256
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114921764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1014 LAMOND AVE",
"city": "DURHAM",
"state": "NC",
"postal_code": "277012021",
"telephone_number": "919-682-5327",
"fax_number": "919-688-4588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1014 LAMOND AVE",
"city": "DURHAM",
"state": "NC",
"postal_code": "277012021",
"telephone_number": "919-682-5327",
"fax_number": "919-688-4588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIST",
"first_name": "ELLIS",
"middle_name": "KNOX",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "5687",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "30-01-8657",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD #",
"identifier": "27028-1",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- 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; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.