Stephen Mark Shall, D.D.S.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

30.016634 Issued in OH

Practice address

5690 Monroe St
Sylvania, OH 43560-2736

Phone

(419) 479-3939

Fax

(419) 479-3933

NPI assigned

Jun 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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 Surgery

Education

Ohio State University College of Dentistry, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Western Lake Erie Oms LTD.Group PAC ID 8022908136, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Western Lake Erie Oms LTD.

  • Oral and Maxillofacial Surgery Clinic/Center
  • Sylvania, OH
  • NPI 1538380662
  Medicare reassignment Care Compare group Authorized official
• Lawrence W Pompili DDS PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Monroe, MI
  • NPI 1689906349
  NPD

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1215932504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5690 MONROE ST",
            "address_2": "STE A",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602736",
            "telephone_number": "419-479-3939",
            "fax_number": "419-479-3933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5690 MONROE ST",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602736",
            "telephone_number": "419-479-3939",
            "fax_number": "419-479-3933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHALL",
        "first_name": "STEPHEN",
        "middle_name": "MARK",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "16634",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OH",
            "license": "30.016634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0515599",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaylin Sevrence
• Joseph J Sferra, M.D.
• Tarif Shaaban, MD
• Muna Shaaeli, MD
• David A Shall, D.D.S., MD
• Shang Y. Rhee, M.D. and Associates, Inc.
• David Shannon
• Joanna F Shaw, CNP
• Emiley F.W. Shenk
• Pamela J Sheridan, D.P.M.

• Oral & Maxillofacial Surgery (D.M.D.) in Sylvania, OH
• Providers in Sylvania, OH by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; 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.