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TY ELLSWORTH DMD
NPI 1699124123
Dentist in Show Low, AZ

Active since June 06, 2016PECOS Enrolled
2650 E SHOW LOW LAKE RD STE 1, SHOW LOW, AZ 85901(928) 537-4300(928) 532-6901 Get Directions Write a Review

NPPES record last updated: April 21, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Apr 21, 2026, Jun 28, 2021 (2 updates tracked since 2021).

About Ty Ellsworth Dmd NPPES

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

TY ELLSWORTH DMD (NPI 1699124123) is an individual dentist in Show Low, Arizona, licensed in Arizona (D009461) and active in the NPI registry since June 2016. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1699124123
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameTY ELLSWORTHCredential: DMD
Location Address2650 E SHOW LOW LAKE RD STE 1Show Low, AZ 85901-7955
Mailing AddressPo Box 1231Tucson, AZ 85702-1231 · (520) 670-3909 · Fax (520) 309-2560
Phone(928) 537-4300
Fax(928) 532-6901
Sole ProprietorNo
Enumeration DateJune 6, 2016
Last NPPES UpdateApril 21, 20262 updates tracked since enumeration
NPPES CertifiedApril 21, 2026
✔ NPI 1699124123 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in AZ · D009461
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
2650 E SHOW LOW LAKE RD STE 1, Show Low, AZ 85901
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter Health, Anthem Blue Cross and Blue Shield and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ty 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.

Medicare Billing Reassignment

Medicare enrollment records show Ty Ellsworth reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

El Rio Santa Cruz Neighborhood Health Center, Inc
144 mi
Federally Qualified Health Center (FQHC)
3655 E GRANT RD
Tucson, AZ 85716
  • Reassigned Medicare billing, Arizona enrollment
  • 464 clinicians in this Medicare group
NPI 1477204485 (520) 670-3090

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85901 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
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$69.24 typical visit price
range $17.72 – $137.41
Typical copayment $17.31 (range $4.43 – $34.35)
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 7

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

ALISON IVERSON NP
Nurse Practitioner (Family)
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Navajo County (928) 537-4300
ELIZABETH MILLER FNP
Nurse Practitioner (Family)
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Navajo County (928) 537-4300
GINA SILVEIRA NP
Nurse Practitioner
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Navajo County (928) 537-4300
AMANDA D FETZNER
Counselor (Professional)
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Navajo County (928) 537-4300
DR. MARIA-LUZ SOTOMAYOR NP
Nurse Practitioner
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Navajo County (928) 537-4300
WILLIAM SMITH LMFT
Marriage & Family Therapist
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Navajo County (928) 537-4300
JILL SHANNON NAVARRO RDH
Dental Hygienist
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Navajo County (928) 537-4300

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 Ty Ellsworth's NPI number?

The NPI number for Ty Ellsworth is 1699124123. It was assigned to this individual provider in the NPPES registry on June 6, 2016.

Where is Ty Ellsworth located?

Ty Ellsworth practices at 2650 E Show Low Lake Rd Ste 1, Show Low, AZ 85901. The listed phone number is (928) 537-4300.

What is Ty Ellsworth's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Ty Ellsworth enrolled in Medicare?

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

Which organization bills Medicare for Ty Ellsworth's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ty Ellsworth reassigns Medicare benefits to El Rio Santa Cruz Neighborhood Health Center, Inc (Tucson, AZ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ty Ellsworth's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Ty Ellsworth accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield of Arizona and Blue Cross and Blue Shield of Montana and 8 other insurers list Ty 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 Ty Ellsworth was last updated on April 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months 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.