Active NPI
Stephen Allen Modelevsky, DDS
- Oral and Maxillofacial Pathology Dentistry
- Jonesboro, AR
National Provider Identifier
1477647089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Pathology Dentistry
- License
- 2302
- Practice address
- 906 Osler Drive
Jonesboro, AR 72401 - Phone
- (870) 972-8570
- Fax
- (870) 972-5451
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 2302 | AR | Primary |
Addresses
Primary practice location
906 Osler Drive
Jonesboro, AR 72401
Mailing address
PO Box 1920
Jonesboro, AR 72403
Phone (870) 972-8570
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 4, 2017 through Dec 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477647089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1920",
"city": "JONESBORO",
"state": "AR",
"postal_code": "72403",
"telephone_number": "870-972-8570",
"fax_number": "870-972-5451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "906 OSLER DRIVE",
"city": "JONESBORO",
"state": "AR",
"postal_code": "72401",
"telephone_number": "870-972-8570",
"fax_number": "870-972-5451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODELEVSKY",
"first_name": "STEPHEN",
"middle_name": "ALLEN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "AR",
"license": "2302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.