DR. ELLEN RENEE WYANT D.M.D.
NPI 1144389396
Dentist - General Practice in Niles, MI

Q: What is Ellen Wyant's NPI number?

The NPI number for Ellen Wyant is 1144389396. It was assigned to this individual provider in the NPPES registry on December 6, 2006. The provider is also known as Mrs. Ellen Renee Petro.

Q: What is Ellen Wyant's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Ellen Wyant was last updated on March 3, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 06, 2006PECOS Enrolled

104 GRANT ST, NILES, MI 49120(269) 683-1077(269) 684-5305 Get Directions Write a Review

NPPES record last updated: March 3, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Dr. Ellen Renee Wyant D.m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ELLEN RENEE WYANT D.M.D. (NPI 1144389396) is an individual general practice provider in Niles, Michigan, licensed in Michigan (2901015477) and active in the NPI registry since December 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1144389396

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameDR. ELLEN RENEE WYANTCredential: D.M.D.

Location Address104 GRANT STNiles, MI 49120-2201

Mailing Address104 Grant StNiles, MI 49120-2201 · (269) 683-1077 · Fax (269) 684-5305

Phone(269) 683-1077

Fax(269) 684-5305

Sole ProprietorNo

Enumeration DateDecember 6, 2006

Last NPPES UpdateMarch 3, 2015

✔ NPI 1144389396 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in MI · 2901015477

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

104 GRANT ST, Niles, MI 49120

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Other Names 1

Other Name (5)Mrs. Ellen Renee Petro

Other Identifiers 1

Medicaid4498490MI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Ellen Renee Wyant D.m.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49120 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.74 typical visit price

range $54.34 – $166.68

Typical copayment $21.18 (range $13.58 – $41.67)

Most-billed visit code 99203

Established Patient

$68.07 typical visit price

range $17.09 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DARRIN GOURLAY D.D.S.

Dentist (General Practice)

104 GRANT ST
NILES, MI 49120

Berrien County (269) 683-1077

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ellen Wyant's NPI number?

The NPI number for Ellen Wyant is 1144389396. It was assigned to this individual provider in the NPPES registry on December 6, 2006. The provider is also known as Mrs. Ellen Renee Petro.

Where is Ellen Wyant located?

Ellen Wyant practices at 104 Grant St, Niles, MI 49120. The listed phone number is (269) 683-1077.

What is Ellen Wyant's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Ellen Wyant enrolled in Medicare?

Yes. Ellen Wyant is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ellen Wyant was last updated on March 3, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.