DR. SHANE L ELLSWORTH DMD
NPI 1639379522
Dentist - General Practice in Mcminnville, OR

Q: What is Shane Ellsworth's NPI number?

The NPI number for Shane Ellsworth is 1639379522. It was assigned to this individual provider in the NPPES registry on July 19, 2007.

Q: What is Shane Ellsworth'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 Shane Ellsworth was last updated on January 6, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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 July 19, 2007PECOS Enrolled

704 NE EVANS ST, MCMINNVILLE, OR 97128(503) 472-1404 Get Directions Write a Review

NPPES record last updated: January 6, 2011. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Dr. Shane L Ellsworth Dmd NPPES

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

DR. SHANE L ELLSWORTH DMD (NPI 1639379522) is an individual general practice provider in Mcminnville, Oregon, licensed in Oregon (D9517) and active in the NPI registry since July 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1639379522

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. SHANE L ELLSWORTHCredential: DMD

Location Address704 NE EVANS STMcminnville, OR 97128-3926

Mailing Address704 Ne Evans StMcminnville, OR 97128-3926 · (503) 472-1402

Phone(503) 472-1404

Sole ProprietorYes

Enumeration DateJuly 19, 2007

Last NPPES UpdateJanuary 6, 2011

✔ NPI 1639379522 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in OR · D9517

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.

704 NE EVANS ST, Mcminnville, OR 97128

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Other Identifiers 1

Medicaid004011136CT

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

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. Shane L Ellsworth Dmd 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 97128 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

$84.82 typical visit price

range $54.96 – $166.64

Typical copayment $21.20 (range $13.74 – $41.66)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.68 – $136.19

Typical copayment $17.16 (range $4.42 – $34.04)

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.

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 Shane Ellsworth's NPI number?

The NPI number for Shane Ellsworth is 1639379522. It was assigned to this individual provider in the NPPES registry on July 19, 2007.

Where is Shane Ellsworth located?

Shane Ellsworth practices at 704 NE Evans St, Mcminnville, OR 97128. The listed phone number is (503) 472-1404.

What is Shane Ellsworth's specialty?

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

Is Shane Ellsworth enrolled in Medicare?

Yes. Shane Ellsworth is registered in the Medicare PECOS enrollment system.

What insurance does Shane Ellsworth accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 4 other insurers list Shane Ellsworth as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shane Ellsworth was last updated on January 6, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.