Chase Daniel Ellis, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DS041898 Issued in PA

Practice address

1019 Ghaner Rd Ste 100
Port Matilda, PA 16870-7236

Phone

(814) 238-7120

Fax

(814) 238-2981

NPI assigned

Jun 6, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Dental Care PC, Inc

  • Pediatric Dentistry
  • Port Matilda, PA
  • NPI 1972673010
  NPD (past)

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1952830689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 GHANER RD STE 100",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707236",
            "telephone_number": "814-238-7120",
            "fax_number": "814-238-2981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 GHANER RD STE 100",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707236",
            "telephone_number": "814-238-7120",
            "fax_number": "814-238-2981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 Forbes Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152133410",
            "country_code": "US",
            "telephone_number": "412-647-6340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CHASE",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS-041898",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": "DS041898",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1035609330001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Drayer Physical Therapy Institute LLC
• Crystal Michele Duffy, DO
• Marten Boyd Duncan, D.O.
• Mona D Duncan, M.D.
• Kathryn K Eisenhuth, MD
• Hannah Fanelli, MD
• Wendy M Felice, PT
• Kristi Fisher, PTA
• Carolyn Grace Folmar, PA-C
• Linda Franchock, BCBA

• Pediatric Dentistry in Port Matilda, PA
• Providers in Port Matilda, PA by specialty
• Pediatric Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.