JUSTINE SHERYLYN MOE (MD, DDS) – Oral and Maxillofacial Surgery (Dentist), NPI 1104143833
Oral and Maxillofacial Surgery (Dentist)
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
76 MAXILLOFACIAL SURGERY in MI
Provider Addresses for JUSTINE SHERYLYN MOE (MD, DDS)
4500 Cascade Rd SE Ste 208
Grand Rapids, MI 495463665
Phone: (616) 977-5000
Fax: (616) 977-0020
Type: Location
5238 W St Joe Hwy Ste 2
Lansing, MI 489174085
Phone: (517) 323-1000
Fax: (517) 886-5566
Type: Location
2240 S State Rd
Ionia, MI 488462149
Phone: (616) 523-9000
Fax: (616) 523-9001
Type: Location
1500 EAST MEDICAL CENTER DRIVE
MED INN ROOM C233A
ANN ARBOR, MI 481095831
Phone: (734) 763-5963
Type: Location
3621 S STATE ST
ANN ARBOR, MI 481081633
Phone: (734) 647-5299
Type: Mailing
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 481095000
Phone: (734) 936-4000
Type: Location
4201 OKEMOS RD
OKEMOS, MI 488643200
Phone: (517) 349-8383
Fax: (517) 349-5566
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 11 Open Payments records for all available years, with a total value of $784.
Total Amount is formed as General ($784) + Research ($0) + Ownership ($0) = $784.
Last reported payment date: 2024-11-09 • Largest payer in this snapshot: AXOGEN ($460).
Total Amount
$784
General + Research + Ownership
Payments
11
Total payment records
General Amount
$784
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-09
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| AXOGEN | $460 |
| KLS-Martin L.P. | $324 |
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: 2018-09-06
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 |
|---|---|---|---|---|
| I20180906002293 | I | Maxillofacial Surgery | MI | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 58 | 40 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 53 | 42 | $0 |
| 70355 | X-ray of lower jaws, upper jaws and teeth | 28 | 27 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 23 | 23 | $0 |
| 15275 | Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less | 13 | 13 | $0 |
Insurance plans in this area (ZIP 49546)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Oral Surgery | MI | |
| Maxillofacial Surgery | MI | |
| Maxillofacial Surgery | MI | |
| Maxillofacial Surgery, Oral Surgery | MI | |
| Maxillofacial Surgery, Oral Surgery | MI |
Reviews
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