MASON MCGILLICUDDY DDS
NPI 1124557699
Dentist in Grand Rapids, MI

Q: What is Mason Mcgillicuddy's NPI number?

The NPI number for Mason Mcgillicuddy is 1124557699. It was assigned to this individual provider in the NPPES registry on June 8, 2017.

Q: What is Mason Mcgillicuddy's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Active since June 08, 2017PECOS Enrolled

100 CHERRY ST SE, GRAND RAPIDS, MI 49503(616) 965-8200(616) 940-5366 Get Directions Write a Review

NPPES record last updated: June 8, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Mason Mcgillicuddy Dds NPPES

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

MASON MCGILLICUDDY DDS (NPI 1124557699) is an individual dentist in Grand Rapids, Michigan, licensed in Michigan (UNKNOWN) and active in the NPI registry since June 2017. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124557699

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameMASON MCGILLICUDDYCredential: DDS

Location Address100 CHERRY ST SEGrand Rapids, MI 49503-4526

Mailing Address100 Cherry St SeGrand Rapids, MI 49503-4526 · (616) 965-8200 · Fax (616) 940-5366

Phone(616) 965-8200

Fax(616) 940-5366

Sole ProprietorNo

Enumeration DateJune 8, 2017

✔ NPI 1124557699 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in MI · UNKNOWN

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

100 CHERRY ST SE, Grand Rapids, MI 49503

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mason Mcgillicuddy Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49503 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

$84.74 typical visit price

range $54.34 – $166.68

Typical copayment $21.18 (range $13.58 – $41.67)

Most-billed visit code 99203

Established Patient

$68.07 typical visit price

range $17.09 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

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 20

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

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