Ryan Ellis, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

53786 Issued in CA

Practice address

5479 N Fresno St Ste 104
Fresno, CA 93710-8328

Phone

(559) 439-5280

NPI assigned

Feb 27, 2009

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

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 Apr 26, 2013 through Apr 26, 2027

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235692800000",
    "number": "1235379454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1495 10TH AVE APT 3",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941223670",
            "telephone_number": "415-420-2824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5479 N FRESNO ST STE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937108328",
            "telephone_number": "559-439-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-27",
        "last_updated": "2009-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "53786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Arnold Ellis
• Jane Mary Lou Ellis
• Kiona Ellis
• Makayla B Ellis
• Natalie Ann Ellis
• Theresa Ellison, LMFT
• Tuswana Makini Ellsberry, FNP
• Victoria Ernestina Ellsworth, MD
• Elmer Wong OD
• Karim Elmobdy

• Periodontics in Fresno, CA
• Providers in Fresno, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2009; 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.