Ezio Novelli, DDS, MD

Primary specialty

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

License

4301109597 Issued in MI

Practice address

4201 Okemos Rd
Okemos, MI 48864

Phone

(517) 349-8383

NPI assigned

Jun 5, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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: Oral Surgery

Education

University of Michigan School of Dentistry, 2016

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)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Oral Surgery Associates of Lansing PC

  dba Ionia Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Lansing, MI
  • NPI 1881797983
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1558622712",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 OKEMOS RD",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "48864",
            "telephone_number": "517-349-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVELLI",
        "first_name": "EZIO",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-05",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "2901020703",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MI",
            "license": "4301109597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northvale LLC
• Northvale LLC
• Charlotte Noto
• Nova Therapeutic Management LLC
• Thomas W Novak, FLP
• Mary Nowack, PHD
• Gerald Vincent Nowinski, DDS
• Douglas Nunn, D.O.
• Joella Ochaba
• Frank Martin Ochberg, MD

• Oral & Maxillofacial Surgery (D.M.D.) in Okemos, MI
• Providers in Okemos, MI by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; 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.