DR. JACK CAPODICE JR. MD, DMD
NPI 1053397612
Dentist - Oral and Maxillofacial Surgery in Bloomington, IL

Q: What is Jack Capodice's NPI number?

The NPI number for Jack Capodice is 1053397612. It was assigned to this individual provider in the NPPES registry on December 15, 2005.

Q: What is Jack Capodice's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Q: When was this NPI record last updated?

The NPPES record for Jack Capodice was last updated on April 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 15, 2005PECOS EnrolledAccepts Medicare Assignment

109 N REGENCY DR, BLOOMINGTON, IL 61701(309) 663-2526(309) 663-4788 Get Directions Write a Review

NPPES record last updated: April 6, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 6, 2026, Mar 7, 2023, Aug 16, 2022 and 1 more (4 updates tracked since 2019).

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About Dr. Jack Capodice Jr. Md, Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK CAPODICE JR. MD, DMD (NPI 1053397612) is an individual oral and maxillofacial surgery provider in Bloomington, Illinois, licensed in Illinois (019022744) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS and is a graduate of University Of Missouri, Columbia School Of Medicine (1990).

NPPES Registry Identity

NPI1053397612

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameDR. JACK CAPODICE JR.Credential: MD, DMD

Location Address109 N REGENCY DRBloomington, IL 61701-3515

Mailing Address109 N Regency DrBloomington, IL 61701-3515 · (309) 663-2526 · Fax (309) 663-4788

Phone(309) 663-2526

Fax(309) 663-4788

Sole ProprietorNo

Medical School CMSUniversity Of Missouri, Columbia School Of MedicineGraduated 1990

Enumeration DateDecember 15, 2005

Last NPPES UpdateApril 6, 20264 updates tracked since enumeration

NPPES CertifiedApril 6, 2026

✔ NPI 1053397612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in IL · 019022744

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

109 N REGENCY DR, Bloomington, IL 61701

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jack Capodice Jr. Md, Dmd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2668420860

PECOS Enrollment IDI20050105000094

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more 99202

This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.

13 services13 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ANTHONY MITCHELL ELGER DMD

Dentist (Oral and Maxillofacial Surgery)