DR. JACK JR. CAPODICE (MD, DMD) – Oral and Maxillofacial Pathology Dentistry, NPI 1053397612
Oral and Maxillofacial Pathology Dentistry
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
56 ORAL SURGERY in IL
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Provider Addresses for DR. JACK JR. CAPODICE (MD, DMD)
109, North Regency Drive, Bloomington, McLean County, Illinois, 61701, United States
BLOOMINGTON, IL 617013515
Phone: (309) 663-2526
Fax: (309) 663-4788
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 16 Open Payments records for all available years, with a total value of $424.
Total Amount is formed as General ($424) + Research ($0) + Ownership ($0) = $424.
Last reported payment date: 2024-12-13 • Largest payer in this snapshot: BioHorizons Implant Systems Inc. ($331).
Total Amount
$424
General + Research + Ownership
Payments
16
Total payment records
General Amount
$424
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| BioHorizons Implant Systems Inc. | $331 |
| ZIMVIE INC. | $71 |
| Straumann USA LLC | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-01-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050105000094 | I | Oral Surgery | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99202 | New patient office or other outpatient visit, 15-29 minutes | 22 | 22 | $0 |
Insurance plans in this area (ZIP 61701)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Oral Surgery | IL | |
| Oral Surgery, Maxillofacial Surgery | IL | |
| Oral Surgery, Maxillofacial Surgery | IL |
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