John C. Eliassen, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

8167 Issued in SC

Practice address

719 Okatie Hwy # 170
Okatie, SC 29909-3963

Phone

(843) 987-7400

NPI assigned

Jul 4, 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

Enrolled in SC

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EICIBD

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.

• Beaufort Jasper Hampton Comprehensive Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ridgeland, SC
  • NPI 1649276148

  SC

  Medicare reassignment NPD
• Beaufort Jasper Hampton Comprehensive Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Varnville, SC
  • NPI 1073318259
  NPD

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1750311684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 10TH ST",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299352422",
            "telephone_number": "843-521-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 OKATIE HWY # 170",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-987-7400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6315 Jonathan Francis SR Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Helena Island",
            "state": "SC",
            "postal_code": "299205310",
            "country_code": "US",
            "telephone_number": "843-838-2086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELIASSEN",
        "first_name": "JOHN",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "8167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX8167",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Harrington Deleon, M.D.
• Alexandra Dickason
• DLS Homecare
• Rhonda Michelle Durham, A-GNP-C
• Christopher James Egan, PA-C
• Chanda Trishaune Elzie Medlock, D.D.S.
• Fast Response Nurse Practitioners LLC
• Mary Lafrance Ferguson, M.D.
• Ines D Figueroa
• Firstchoice Healthcare PC

• All providers in Okatie, SC
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; 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.

Verify at the official NPI Registry.