Individual provider Active NPI

Anthony Mitchell Elger, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Bloomington, IL
National Provider Identifier
1114363579
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
01902926 Issued in IL
Practice address
109 N Regency Dr
Bloomington, IL 61701-3515
Phone
(309) 663-2526
Fax
(309) 663-4788
NPI assigned
May 13, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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 01902926 IL
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 01902926 IL Primary

Addresses

Primary practice location

109 N Regency Dr
Bloomington, IL 61701-3515

Mailing address

109 N Regency Dr
Bloomington, IL 61701-3515
Phone (309) 663-2526

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200630001425 IL Practitioner - Oral Surgery 7719277938 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Southern Illinois Univ School of Dental Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capodice Efaw Ocheltree and Elger PLLCGroup PAC ID 5597713792, 5 clinicians

Practice addresses (Care Compare)

109 N Regency Dr
Bloomington, IL 61701-3515
Phone (309) 663-2526

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
01902926ILMDOral and Maxillofacial Pathology Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Capodice, Efaw, Ocheltree & Elger PLLC Oral and Maxillofacial Surgery CurrentSince Mar 19, 2020 Accepting new patients

Locations

109 N Regency Dr
Bloomington, IL 61701
Phone (309) 663-2526

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1368403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1114363579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N REGENCY DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013515",
            "telephone_number": "309-663-2526",
            "fax_number": "309-663-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N REGENCY DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013515",
            "telephone_number": "309-663-2526",
            "fax_number": "309-663-4788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELGER",
        "first_name": "ANTHONY",
        "middle_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-13",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "IL",
            "license": "01902926",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "01902926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.