FACE AND JAW SURGEONS PC
NPI 1104863505
Dentist - Oral and Maxillofacial Surgery in Minot, ND
About Face And Jaw Surgeons Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FACE AND JAW SURGEONS PC (NPI 1104863505) is a healthcare organization registered as an oral and maxillofacial surgery in Minot, North Dakota and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through August 27, 2028 and lists Joseph R Deatherage, Dmd Md, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Face And Jaw Surgeons Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
14Medicare enrollment records show 14 clinicians reassign Medicare billing to Face And Jaw Surgeons PC, which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians by Medicare Specialty 3
Clinicians, nearest first (14)
Minneapolis, MN 55455
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 35D1058032
Face And Jaw Surgery Center · Bismarck, NDFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Face And Jaw Surgeons PC's NPI number?
The NPI number for Face And Jaw Surgeons PC is 1104863505. It was assigned to this organization in the NPPES registry on June 2, 2006.
Where is Face And Jaw Surgeons PC located?
Face And Jaw Surgeons PC is located at 2615 Elk Dr Suite 3, Minot, ND 58701. The listed phone number is (701) 852-3421.
What is Face And Jaw Surgeons PC's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.
Is Face And Jaw Surgeons PC enrolled in Medicare?
Yes. Face And Jaw Surgeons PC is registered in the Medicare PECOS enrollment system.
When is Face And Jaw Surgeons PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (North Dakota, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Face And Jaw Surgeons PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 14 clinicians in 3 Medicare specialties reassign their Medicare billing to Face And Jaw Surgeons PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Certified Registered Nurse Anesthetist (CRNA) (7), Oral Surgery (6) and Maxillofacial Surgery (1). Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Face And Jaw Surgeons PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 35D1058032) is associated with this NPI, valid through August 27, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Face And Jaw Surgeons PC was last updated on June 8, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years 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.
# Face And Jaw Surgeons Pc · NPI 1104863505
Oral and Maxillofacial Surgery organization in Minot, North Dakota. Organization record, active in the CMS NPPES registry since June 2, 2006.
## Identity
- **NPI:** 1104863505 (Entity type: Organization)
- **Enumerated:** June 2, 2006
- **Primary specialty:** Dentist - Oral and Maxillofacial Surgery · taxonomy 1223S0112X
- **Organization subpart:** No
- **Authorized official:** Joseph Deatherage, DMD MD
## Practice location
- **Address:** 2615 ELK DR, SUITE 3, Minot, ND 58701-1200
- **Phone:** (701) 852-3421 · **Fax:** (701) 838-1842
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (Non-DME Part B, North Dakota, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 14 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Certified Registered Nurse Anesthetist (CRNA) (7), Oral Surgery (6), Maxillofacial Surgery (1) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 8, 2017
- **Other identifiers:** Medicaid 41328 (ND); Medicare PIN N70243
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104863505) · Data from the CMS NPPES public registry.