Larry Johnson Ellison, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

5949 Issued in NE

Practice address

615 N 90TH St
Omaha, NE 68114-2821

Phone

(402) 393-5050

Fax

(402) 393-3401

NPI assigned

Sep 20, 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

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 28, 2015 through Jul 28, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Heartland Endodontic Specialists, LLC

  • Endodontics
  • Omaha, NE
  • NPI 1871690842
  NPD (past) Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219881600000",
    "number": "1235236217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N 90TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142821",
            "telephone_number": "402-393-5050",
            "fax_number": "402-393-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N 90TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142821",
            "telephone_number": "402-393-5050",
            "fax_number": "402-393-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "LARRY",
        "middle_name": "JOHNSON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NE",
            "license": "5949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHILED",
            "identifier": "04989",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Ellis, LIMHP
• Tedette L Ellis, A.P.R.N.
• Timothy Ray Ellis, D.D.S
• Zarriya Ellis
• Joseph Robert Ellison, M.D.
• Melissa Anne Ellison, MS
• Moataz Ellithi, MD.
• Steven Elloie
• Rebecca Ruth Ellsworth, PA-C
• Mary Kathryn Ellwanger, APRN-NP, CPNP-PC

• Endodontics in Omaha, NE
• Providers in Omaha, NE by specialty
• Endodontics in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; 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.

Verify at the official NPI Registry.