Ellen Fischer, DDS
Individual provider Active NPI Dentist · Rochester, IL
NPI 1609967694 · NPPES record last updated Sep 25, 2014
Key facts
- NPI
- 1609967694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.028607 (IL)
- Practice address
- 318 Sattley St
Rochester, IL 62563-9241 - Phone
- (217) 498-3622
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150331000146 | IL | Order and Referring Only - Oral Surgery |
6901123090 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.028607 | IL | MD | Dentist |
| 5984-015 | WI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5984-015 | WI | |
| Dentist | 122300000X | 019.028607 | IL | Yes |
Addresses
Primary practice location
318 Sattley St
Rochester, IL 62563-9241
Mailing address
318 Sattley St
PO Box 55
Rochester, IL 62563-9241
Phone (217) 498-3622
Other names
- Dr. Ellen Underwood
Other providers in Rochester, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.