DR. CHARLES LEE ELLIS DDS, MD
NPI 1013098698
Dentist - Oral and Maxillofacial Surgery in Green Bay, WI
NPI Status: Active since October 18, 2006
Contact Information
2353 S RIDGE ROAD
GREEN BAY, WI
ZIP 54304
Phone: (920) 499-0471
Fax: (920) 499-8312
- Individual
- Male
- Dentist
- Oral and Maxillofacial Surgery
- Accepts Insurance
- PECOS Enrolled
- Opted-Out Medicare
About CHARLES ELLIS
This page provides the complete NPI Profile along with additional information for Charles Ellis, a provider established in Green Bay, Wisconsin with a medical specialization in Dentist, focusing in oral and maxillofacial surgery . The healthcare provider is registered in the NPI registry with number 1013098698 assigned on October 2006. The practitioner's primary taxonomy code is 1223S0112X with license number 8919 (NC). The provider is registered as an individual and his NPI record was last updated one year ago.
- NPI
- 1013098698
- Provider Name
- DR. CHARLES LEE ELLIS DDS, MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 2353 S RIDGE ROAD GREEN BAY, WI 54304
- Location Phone
- (920) 499-0471
- Location Fax
- (920) 499-8312
- Mailing Address
- 2353 S RIDGE ROAD GREEN BAY, WI 54304
- Mailing Phone
- (920) 499-0471
- Mailing Fax
- (920) 499-8312
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 10-18-2006
- Last Update Date
- 08-20-2025
- Code Navigator
A dentist like Charles Ellis is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Charles Ellis opted out of Medicare effective on 05-01-2021 until 05-01-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dentist Oral and Maxillofacial Surgery
- Taxonomy Code
- 1223S0112X
- Type
- Dental Providers
- License No.
- 8919
- License State
- NC
- Taxonomy Description
- An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 122300000X | Dental Providers | Dentist | 8919 (NC) |
| 2 | 1223S0112X | Dental Providers | Dentist | 0401411258 (VA) |
| 3 | 1223S0112X | Dental Providers | Dentist | 019022235 (IL) |
| 4 | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | 0101058265 (VA) |
| 5 | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | 8919 (NC) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Delta Dental Individual and Family High Plan - PPO
- Delta Dental Individual and Family Low Plan - PPO
- Delta Dental Individual and Family Low Plan Major - PPO
- Delta Dental PPO Plus Premier Family Plan High Option - PPO
- Delta Dental PPO Plus Premier Family Plan Low Option - PPO
- Humana Dental Smart Choice - PPO
- Humana Dental Smart Choice - Basic - PPO
- Humana Dental Smart Choice - High - PPO
- Humana Dental Smart Choice - Lite - PPO
- Humana Dental Smart Choice - Low - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 5914023 | MEDICAID (05) | NC |
Medicare Participation & PECOS Enrollment Status
Charles Ellis is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME) and a Home Health Agency (HHA).
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 05-01-2021
Opt-Out End Date: 05-01-2027
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: No
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 54304 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $82.92
- Minimum New Patient Price $53.9
- Maximum New Patient Price $163.24
- Average New Patient Copayment $20.73
- Minimum New Patient Copayment $13.47
- Maximum New Patient Copayment $40.81
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $67.37
- Minimum Established Patient Price $17.4
- Maximum Established Patient Price $133.76
- Average Established Patient Copayment $16.84
- Minimum Established Patient Copayment $4.35
- Maximum Established Patient Copayment $33.44
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1013098698, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 62. The final step is to find the difference between that total and the next multiple of ten (70 - 62 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 62 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
GREEN BAY, WI 54304
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1013098698, enumerated as an "individual" on October 18, 2006.
The provider is located at 2353 S RIDGE ROAD GREEN BAY, WI 54304 and the phone number is (920) 499-0471.
Dentist with taxonomy code 1223S0112X and a focus in Oral and Maxillofacial Surgery.
The provider might be accepting Accepts: Delta Dental of Wisconsin, Inc., Humana, Medicare. Please consult your insurance carrier or call the provider to verify.
