Active NPI
Jon Charles Ellison, D.D.S.
- General Practice Dentistry
- Simi Valley, CA
National Provider Identifier
1497841134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 25136
- Practice address
- 1939 Erringer Rd
Simi Valley, CA 93065-3524 - Phone
- (805) 527-6100
- Fax
- (805) 527-0038
- NPI assigned
- Oct 4, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 25136 | CA | Primary |
Addresses
Primary practice location
1939 Erringer Rd
Simi Valley, CA 93065-3524
Mailing address
1939 Erringer Rd
Simi Valley, CA 93065-3524
Phone (805) 527-6100
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161028002028 | CA | Order and Referring Only - Dentist | 8426336207 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25136 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497841134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1939 ERRINGER RD",
"city": "SIMI VALLEY",
"state": "CA",
"postal_code": "930653524",
"telephone_number": "805-527-6100",
"fax_number": "805-527-0038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1939 ERRINGER RD",
"city": "SIMI VALLEY",
"state": "CA",
"postal_code": "930653524",
"telephone_number": "805-527-6100",
"fax_number": "805-527-0038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "JON",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "25136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Simi Valley, CA
- Aljo Batin Elizarde, FNP-C
- Darelle Faith Elizarde, RN
- Amal Elkhouli, MD
- Jaayda Ellingham, M.A., LMFT
- Joanne Evelyn Ellis
- Marissa Garcia Elpidama, PSY.D.
- Elysium Hospice Care, Inc.
- Emanate Professional Clinical Counselor Inc
- Emerald Home Health Inc
- Emotive Marriage and Family Therapy Professional Corporation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.