Individual provider Active NPI

Lauren Graham Bourell, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Sylvania, OH
National Provider Identifier
1295908028
Registry record updated Aug 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
30.024410 Issued in OH
Practice address
5690 Monroe St
Sylvania, OH 43560-2736
Phone
(419) 479-3939
NPI assigned
Apr 13, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2019

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 Surgery (Dentist) 1223S0112X 30.024410 OH
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 30.024410 OH Primary

Addresses

Primary practice location

5690 Monroe St
Sylvania, OH 43560-2736

Mailing address

5690 Monroe St
Sylvania, OH 43560-2736
Phone (419) 479-3939

Other names 1

  • Lauren Graham Posluszny Former name

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161007000554 OH Practitioner - Oral Surgery 7012205065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
New York University School of Medicine, 2012
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)

5690 Monroe St
Sylvania, OH 43560-2736
Phone (419) 479-3939

National Provider Directory

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

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": "1208044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1295908028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5690 MONROE ST",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602736",
            "telephone_number": "419-479-3939"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURELL",
        "first_name": "LAUREN",
        "middle_name": "GRAHAM",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-13",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30.024410",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OH",
            "license": "30.024410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAUREN",
            "last_name": "POSLUSZNY",
            "middle_name": "GRAHAM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sylvania, OH

Sources for this page

Verify at the official NPI Registry.