Erik V Ellingsworth, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30020995 Issued in OH

Practice address

447 Nilles Rd
Suite 6
Fairfield, OH 45014-2633

Phone

(513) 829-1117

Fax

(513) 829-2881

NPI assigned

Jun 16, 2006

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 OH

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

State licenses

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1144264128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 NILLES RD",
            "address_2": "SUITE 6",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450142633",
            "telephone_number": "513-829-1117",
            "fax_number": "513-829-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 NILLES RD",
            "address_2": "SUITE 6",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450142633",
            "telephone_number": "513-829-1117",
            "fax_number": "513-829-2881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSWORTH",
        "first_name": "ERIK",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30020995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1144264128",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jazmin Rochelle Edwards, RN
• Ali Elazab, MD
• Brianna Elder, MS, CCC-SLP
• Walter Samuel Elijah
• Elite Comfort Home Care LLC
• Shana Ellison
• Ashley Emm
• Emp
• Empowered Living Health Services, LLC
• Carrie Engel, LPN

• All providers in Fairfield, OH
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; 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.