Jon Matthew Ellenbecker, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

M887 Issued in SD

Practice address

5201 S Western Ave
Sioux Falls, SD 57108-5004

Phone

(605) 339-2200

Fax

(605) 334-5530

NPI assigned

Oct 11, 2006

Last updated

Jul 8, 2007By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

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

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.

• South Western Dental

  • General Practice Dentistry
  • Sioux Falls, SD
  • NPI 1326136607
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982792289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 S WESTERN AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571085004",
            "telephone_number": "605-339-2200",
            "fax_number": "605-334-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 S WESTERN AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571085004",
            "telephone_number": "605-339-2200",
            "fax_number": "605-334-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBECKER",
        "first_name": "JON",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "M887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803400",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Eliason, NP
• Elite Home Care LLC
• Elizabeth a Larson Inc
• Bruce Alden Elkins, M.D.
• Darcey Ann Ellefson, RN
• Jori Anne Ellenbecker
• Richard Joseph Ellenbecker, DDS
• Dale D Ellens, LPC LMFT QMHP
• Megan Ellens, CRNA
• David A Ellerbusch, M.D.

• General Practice Dentistry in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• General Practice Dentistry in South Dakota

• 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.

Verify at the official NPI Registry.