NPIMap

Individual provider Active NPI

Edward Ellis III, DDS MS

  • Oral and Maxillofacial Surgery (Dentist)
  • San Antonio, TX
National Provider Identifier
1750348199
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
15787 Issued in TX
Practice address
7703 Floyd Curl Dr
MC 7908
San Antonio, TX 78229-3901
Phone
(210) 567-3465
NPI assigned
Apr 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 15787 TX Primary

Addresses

Primary practice location

7703 Floyd Curl Dr
MC 7908
San Antonio, TX 78229-3901

Mailing address

8210 Floyd Curl Dr
MC 8124
San Antonio, TX 78229-3923
Phone (210) 450-3131

Other identifiers 1

IdentifierTypeStateIssuer
111043901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100220000194 TX Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 5496899007 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial SurgeryAlso: Oral Surgery
Education
University of Michigan School of Dentistry, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Texas Health Science Center at San AntonioGroup PAC ID 0042128548, 1,290 clinicians

Practice addresses (Care Compare)

8210 Floyd Curl Dr
San Antonio, TX 78229-3923
Phone (210) 450-3700

Hospital & facility affiliations

  • University Health System Hospital, San Antonio, TX, CCN 450213

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
15787TXMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Dec 24, 2009 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Health Science Center at San Antonio CurrentSince Apr 1, 2010 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Dec 24, 2009 Accepting new patients
The University of Texas Health Science Center at San Antonio CurrentSince Apr 1, 2010 Accepting new patients

Locations

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3700

8210 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3100

8210 Floyd Curl Dr
#8124
San Antonio, TX 78229
Phone (210) 450-3100

7703 Floyd Curl Dr
#7908
San Antonio, TX 78229
Phone (210) 567-3465

Interoperability endpoints

  • Direct secure messaging: eellis61632@direct.utmsa.com
  • Direct secure messaging: eellis50003@uhssa.direct-ci.com

Organizations & group practices 11

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1750348199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8210 FLOYD CURL DR",
            "address_2": "MC 8124",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293923",
            "telephone_number": "210-450-3131",
            "fax_number": "210-450-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7703 FLOYD CURL DR",
            "address_2": "MC 7908",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293901",
            "telephone_number": "210-567-3465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "EDWARD",
        "name_suffix": "III",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "15787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111043901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.