TY ELLSWORTH DMD
NPI 1699124123
Dentist in Show Low, AZ

Q: 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.

Q: What is Ty Ellsworth's specialty?

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

Q: 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 3 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.

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: August 16, 2026.

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

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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, Anthem Blue Cross and Blue Shield, 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)

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.

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)