Newell Tyler Elison, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-4431 Issued in ID

Practice address

1555 S Lincoln Ave
Jerome, ID 83338-6136

Phone

(208) 644-9166

NPI assigned

Jun 22, 2011

Sex

Male

Sole proprietor

Yes

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 ID

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": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459036800000",
    "number": "1144516733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2264 CANDLERIDGE DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833018321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 S LINCOLN AVE",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833386136",
            "telephone_number": "208-644-9166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELISON",
        "first_name": "NEWELL",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2016-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Duersch, M.D.
• Marylin Eacker, LSW
• Brakeal Edwards
• David Edwards, LPC, LPCC
• Lon Miguel Egbert, PT, ATC
• Tammy Emerson, MS CCC SLP
• Curtis Phillip Emery, RT (R)(CT)
• David J Erickson, DO
• Kyana Evalyn
• Eyecenter PA

• General Practice Dentistry in Jerome, ID
• Providers in Jerome, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.