Active NPI
Steven L. Ellis, LD
- Denturist
- Old Orchard Beach, ME
National Provider Identifier
1255565065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- 5005
- Practice address
- 155 Saco Ave
Old Orchard Beach, ME 04064-1600 - Phone
- (207) 934-5411
- NPI assigned
- May 7, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | 5005 | ME | Primary |
Addresses
Primary practice location
155 Saco Ave
Old Orchard Beach, ME 04064-1600
Mailing address
155 Saco Ave
Old Orchard Beach, ME 04064-1600
Phone (207) 934-5411
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 431742900 | Other | ME | MAINE CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5005 | ME | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241654400000",
"number": "1255565065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 SACO AVE",
"city": "OLD ORCHARD BEACH",
"state": "ME",
"postal_code": "040641600",
"telephone_number": "207-934-5411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 SACO AVE",
"city": "OLD ORCHARD BEACH",
"state": "ME",
"postal_code": "040641600",
"telephone_number": "207-934-5411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "STEVEN",
"middle_name": "L.",
"credential": "LD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-07",
"last_updated": "2009-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "ME",
"license": "5005",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAINE CARE",
"identifier": "431742900",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Old Orchard Beach, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.