Individual provider Active NPI

Thomas Craig Ellerhorst, D.D.S.

  • General Practice Dentistry
  • San Francisco, CA
National Provider Identifier
1174620033
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
26840 Issued in CA
Practice address
2300 Sutter St
# 204
San Francisco, CA 94115-3037
Phone
(415) 921-0434
Fax
(415) 921-0439
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 26840 CA Primary

Addresses

Primary practice location

2300 Sutter St
# 204
San Francisco, CA 94115-3037

Mailing address

2300 Sutter St
# 204
San Francisco, CA 94115-3037
Phone (415) 921-0434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20160523002381 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3274822747

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174620033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 SUTTER ST",
            "address_2": "# 204",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153037",
            "telephone_number": "415-921-0434",
            "fax_number": "415-921-0439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 SUTTER ST",
            "address_2": "# 204",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153037",
            "telephone_number": "415-921-0434",
            "fax_number": "415-921-0439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERHORST",
        "first_name": "THOMAS",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "26840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.