Individual provider Active NPI

John F Neely, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Pinehurst, NC
National Provider Identifier
1073594222
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
7678 Issued in NC
Practice address
93 Aviemore Dr
Pinehurst, NC 28374-9797
Phone
(910) 295-8088
Fax
(910) 295-8855
NPI assigned
Nov 7, 2005
Last updated
Dec 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X 7678 NC
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 7678 NC Primary

Addresses

Primary practice location

93 Aviemore Dr
Pinehurst, NC 28374-9797

Mailing address

93 Aviemore Dr
Pinehurst, NC 28374-9797
Phone (910) 295-8088

Other identifiers 1

IdentifierTypeStateIssuer
89902UXMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040603001442 NC Practitioner - Maxillofacial Surgery 4183606098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial Surgery
Education
University of Pittsburgh School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John F Neely DMD PAGroup PAC ID 7012911860, 2 clinicians

Practice addresses (Care Compare)

93 Aviemore Dr
Pinehurst, NC 28374-9797
Phone (910) 295-8088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7678NCMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
John F Neely DMD PA Single Specialty CurrentSince Jun 1, 2006 Accepting new patients
Gary T. Jones DMD PA Single Specialty PastSince Jun 1, 2006 Accepting new patients

Locations

93 Aviemore Dr
Pinehurst, NC 28374
Phone (910) 295-8088

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1073594222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 AVIEMORE DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283749797",
            "telephone_number": "910-295-8088",
            "fax_number": "910-295-8855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 AVIEMORE DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283749797",
            "telephone_number": "910-295-8088",
            "fax_number": "910-295-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEELY",
        "first_name": "JOHN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NC",
            "license": "7678",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NC",
            "license": "7678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89902UX",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinehurst, NC

Sources for this page

Verify at the official NPI Registry.