Stephen Mark Shall, DDS is a medicare enrolled "Oral & Maxillofacial Surgery" provider in Sylvania, Ohio. He went to Ohio State University College Of Dentistry and graduated in 1978 and has 46 years of diverse experience with area of expertise as Maxillofacial Surgery. He is a member of the group practice Western Lake Erie Oms Ltd. and his current practice location is
5690 Monroe St, Sylvania, Ohio. You can reach out to his office (for appointments etc.) via phone at
(419) 479-3939.
Stephen Mark Shall is licensed to practice in Ohio (license number 30.016634) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1215932504.
Healthcare Provider's Profile
| Full Name | Stephen Mark Shall |
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| Gender | Male |
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| Speciality | Maxillofacial Surgery |
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| Experience | 46 Years |
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| Location | 5690 Monroe St, Sylvania, Ohio |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Stephen Mark Shall attended and graduated from Ohio State University College Of Dentistry in 1978
NPI Data:
- NPI Number: 1215932504
- Provider Enumeration Date: 06/15/2005
- Last Update Date: 08/01/2019
Medicare PECOS Information:
- PECOS PAC ID: 9436040458
- Enrollment ID: I20040323000425
Medical Identifiers
Medical identifiers for Stephen Mark Shall such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1215932504 | NPI | - | NPPES |
| 0515599 | Medicaid | OH | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 16634 (Ohio) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | 30.016634 (Ohio) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Western Lake Erie Oms Ltd. | 8022908136 | 4 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Stephen Mark Shall allows following entities to bill medicare on his behalf.
| Entity Name | Western Lake Erie Oms Ltd. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1538380662
PECOS PAC ID: 8022908136
Enrollment ID: O20040319000945 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Stephen Mark Shall is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Stephen Mark Shall, DDS
5690 Monroe St, Ste A,
Sylvania, OH 43560-2736
Ph: (419) 479-3939 | Stephen Mark Shall, DDS
5690 Monroe St,
Sylvania, OH 43560-2736
Ph: (419) 479-3939 |
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