Justine Sherylyn Moe, MD, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4301111526 Issued in MI

Practice address

4201 Okemos Rd
Okemos, MI 48864-3200

Phone

(517) 349-8383

Fax

(517) 349-5566

NPI assigned

Apr 20, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Maxillofacial SurgeryAlso: Dentist, General Surgery, Oral Surgery

Education

Emory University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oral Surgery Associates of Lansing PCGroup PAC ID 0547349458, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmoe709740@direct.med.umich.edu

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

• Oral Surgery Associates of Lansing PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Lansing, MI
  • NPI 1881797983
  Medicare reassignment Care Compare group NPD
• Edward W Sparrow Hospital Association

  • Surgery Physician
  • Lansing, MI
  • NPI 1457744666
  Medicare reassignment NPD
• Edward W Sparrow Hospital Association

  • Adult Health Nurse Practitioner
  • Lansing, MI
  • NPI 1265220438
  NPD
• Edward W. Sparrow Hospital Association

  • Plastic Surgery Physician
  • Lansing, MI
  • NPI 1801563796
  NPD
• Oral and Maxillofacial Surgery Services, PLC

  • Oral and Maxillofacial Radiology Dentistry
  • Grand Rapids, MI
  • NPI 1548283559

  Oral and Maxillofacial Surgery

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1073588711
  Care Compare affiliation
• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1760710719
  Care Compare affiliation

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1104143833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 OKEMOS RD",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488643200",
            "telephone_number": "517-349-8383",
            "fax_number": "517-349-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 OKEMOS RD",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488643200",
            "telephone_number": "517-349-8383",
            "fax_number": "517-349-5566"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 Cascade Rd SE Ste 208",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495463665",
            "country_code": "US",
            "telephone_number": "616-977-5000",
            "fax_number": "616-977-0020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2240 S State Rd",
            "address_purpose": "LOCATION",
            "city": "Ionia",
            "state": "MI",
            "postal_code": "488462149",
            "country_code": "US",
            "telephone_number": "616-523-9000",
            "fax_number": "616-523-9001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5238 W St Joe Hwy Ste 2",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489174085",
            "country_code": "US",
            "telephone_number": "517-323-1000",
            "fax_number": "517-886-5566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOE",
        "first_name": "JUSTINE",
        "middle_name": "SHERYLYN",
        "credential": "MD, DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-20",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301111526",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "4301111526",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "4301111526",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MI",
            "license": "4301111526",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miotech Orthopedic Sales, LLC
• Rosendo Martinez Mireles Sr.
• Cathyrae Mishoe
• James Robert Mlejnek III
• Emily Mock
• Ilhan Mohamud
• Kamal Mohan, M.D.
• Lisa Mohan, DDS,MPH
• Manoj Mohan, D.O.
• Monika Mohan, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Okemos, MI
• Providers in Okemos, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.