Central Illinois Oral and Maxillofacial Surgery, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

CENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PC

Practice address

14 E Anthony Dr
Suite C
Champaign, IL 61820-2748

Phone

(217) 355-2809

Fax

(217) 355-5921

NPI assigned

Dec 1, 2006

Organization subpart

Yes

Parent organization

CENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PCAs reported in NPPES

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

Authorized official

Name

Amy M Kroeger

Title

Insurance Coordinator

Phone

(217) 540-5100

Specialties & licenses 1

Addresses

Other names 1

• Champaign Oral Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Central Illinois Oral and Maxillofacial Surgery, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Effingham, IL
  • NPI 1891843595

  O20070116000497

  Same enrollment

Part of

Central Illinois Oral Maxillofacial Surgery

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Central Illinois Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Effingham, IL
  • NPI 1679733976
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas W Fonner, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Effingham, IL
  • NPI 1205907581
  Medicare reassignment

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1669540399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 E ANTHONY DR",
            "address_2": "SUITE C",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618202748",
            "telephone_number": "217-355-2809",
            "fax_number": "217-355-5921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 E ANTHONY DR",
            "address_2": "SUITE C",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618202748",
            "telephone_number": "217-355-2809",
            "fax_number": "217-355-5921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PC",
        "enumeration_date": "2006-12-01",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "KROEGER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Champaign Oral Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Champaign Oral Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• CCM Champaign County Mobility LL
• Cindy San Esteban Cecilio, RPT
• Siegfred T. Celis
• Center for Health Renewal and Longevity LLC
• Central Illinois Diagnostic Imaging Center, LLC
• Central Illinois Oral and Maxiofacial Surgery, PC
• Central State Chiropractic & Rehabilitation
• Litzi Ceron-Conde
• Patty Cetin, M.S., CCC-SLP
• Swathi Chalasani, MD

• Oral and Maxillofacial Surgery (Dentist) in Champaign, IL
• Providers in Champaign, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.