Ty Ellsworth, DMD in Show Low, AZ - Medicare Dentist Provider

Ty Ellsworth, DMD is a medicare enrolled "Dentist" provider in Show Low, Arizona. His current practice location is 2650 E Show Low Lake Rd Ste 1, Show Low, Arizona. You can reach out to his office (for appointments etc.) via phone at (928) 537-4300.

Ty Ellsworth is licensed to practice in Arizona (license number D009461) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1699124123.

Contact Information

	Ty Ellsworth, DMD
	2650 E Show Low Lake Rd Ste 1, Show Low, AZ 85901-7955
	(928) 537-4300
	(928) 532-6901

Map and Direction

Healthcare Provider's Profile

Full Name	Ty Ellsworth
Gender	Male
Speciality	Dentist
Location	2650 E Show Low Lake Rd Ste 1, Show Low, Arizona
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1699124123
Provider Enumeration Date: 06/06/2016
Last Update Date: 06/28/2021

Medicare PECOS Information:

PECOS PAC ID: 8325449903
Enrollment ID: I20210702001838

Medical Identifiers

Medical identifiers for Ty Ellsworth such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1699124123	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
122300000X	Dentist	D009461 (Arizona)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ty Ellsworth allows following entities to bill medicare on his behalf.

Entity Name	North Country Healthcare Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1073583472 PECOS PAC ID: 8820981053 Enrollment ID: O20040210001107

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ty Ellsworth is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Ty Ellsworth, DMD Po Box 3630, Flagstaff, AZ 86003-3630 Ph: (928) 522-9879	Ty Ellsworth, DMD 2650 E Show Low Lake Rd Ste 1, Show Low, AZ 85901-7955 Ph: (928) 537-4300

Reviews and Comments

Dentist in Show Low, AZ

Dr. Kyle Thomas, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 5171 S Cub Lake Rd Ste B260, Show Low, AZ 85901 Phone: 928-892-3562
Kuljeet J Bains, Dentist Medicare: Not Enrolled in Medicare Practice Location: 2450 S White Mountain Rd Ste 1, Show Low, AZ 85901 Phone: 928-537-6453 Fax: 928-537-5535
Michael J Snow, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 5171 Cub Lake Road, Building B Suite 260, Show Low, AZ 85901 Phone: 928-532-7669 Fax: 928-537-0333
Dr. Chester Trent Adams, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 51 S White Mountain Rd, Show Low, AZ 85901 Phone: 928-537-1282
Dr. Brennon Lewayne Hancock, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 301 N Central Ave, Show Low, AZ 85901 Phone: 928-537-4363
Dr. Joshua James Beeler, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 51 S White Mountain Rd, Show Low, AZ 85901 Phone: 928-537-7775
Dr. Steven K Shelton, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 51 S White Mountain Rd, Show Low, AZ 85901 Phone: 928-532-3040 Fax: 928-537-2525

Ty Ellsworth, DMD - Medicare Dentist in Show Low, AZ