Michael Leonard Bagnoli

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12008541A Issued in IN

Practice address

2020 Union Street
Suite 200
Lafayette, IN 47904

Phone

(765) 446-8808

Fax

(765) 446-9567

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 20, 2014 through Oct 20, 2026

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: mbagnoli107044@direct.franciscanalliance.org

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 and Maxillofacial Surgery Center of Lafayette

  • Oral and Maxillofacial Surgery (Dentist)
  • Lafayette, IN
  • NPI 1154411163
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700976719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 REDWOOD COURT",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "47904",
            "fax_number": "765-446-9567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 UNION STREET",
            "address_2": "SUITE 200",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "47904",
            "telephone_number": "765-446-8808",
            "fax_number": "765-446-9567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGNOLI",
        "first_name": "MICHAEL",
        "middle_name": "LEONARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12008541A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kari Badger, PT
• Stephen F. Badylak, DVM, MD, PHD
• Shamik Bafna, MD
• Diane Danner Bagnoli, D.D.S.
• Kristina Bagnoli, LMFT
• Electry Saladaga Baguio
• Crisanta Mejia Baguisa, PT
• Amy Bailey
• Colleen Baines, DDS
• Bradford Chandler Baisden, PT

• Oral and Maxillofacial Surgery (Dentist) in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• 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.

Verify at the official NPI Registry.