DR. JOHN DAVID KISELLA D.D.S., M.D
NPI 1174530562
Specialist in Matthews, NC

Q: What is John Kisella's NPI number?

The NPI number for John Kisella is 1174530562. It was assigned to this individual provider in the NPPES registry on August 1, 2006.

Q: What is John Kisella's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Q: Is John Kisella enrolled in Medicare?

No. John Kisella has opted out of Medicare through December 19, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for John Kisella was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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 August 01, 2006Opted out of Medicare · through Dec 19, 2027

1208 MANN DR, SUITE 100, MATTHEWS, NC 28105(704) 846-1166(704) 849-2051 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. John David Kisella D.d.s., M.d NPPES

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

DR. JOHN DAVID KISELLA D.D.S., M.D (NPI 1174530562) is an individual specialist in Matthews, North Carolina and active in the NPI registry since August 2006. He has opted out of Medicare through December 19, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1174530562

Entity TypeIndividualMale

Primary Taxonomy174400000X

Provider Legal NameDR. JOHN DAVID KISELLACredential: D.D.S., M.D

Location Address1208 MANN DR, SUITE 100Matthews, NC 28105-7591

Mailing Address1208 Mann Dr, Suite 100Matthews, NC 28105-7591 · (704) 846-1166 · Fax (704) 849-2051

Phone(704) 846-1166

Fax(704) 849-2051

Sole ProprietorNo

Enumeration DateAugust 1, 2006

Last NPPES UpdateSeptember 11, 2025

✔ NPI 1174530562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Also ListedDentist · Oral and Maxillofacial SurgeryTaxonomy 1223S0112X · License 7871 (NC)

1208 MANN DR, Matthews, NC 28105

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

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Opted out of Medicare

Dr. John David Kisella D.d.s., M.d has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 19, 2019 through December 19, 2027.

Opt-Out Effective DateDecember 19, 2019

Opt-Out In Effect ThroughDecember 19, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Frequently 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 John Kisella's NPI number?

The NPI number for John Kisella is 1174530562. It was assigned to this individual provider in the NPPES registry on August 1, 2006.

Where is John Kisella located?

John Kisella practices at 1208 Mann Dr Suite 100, Matthews, NC 28105. The listed phone number is (704) 846-1166.

What is John Kisella's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is John Kisella enrolled in Medicare?

No. John Kisella has opted out of Medicare through December 19, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does John Kisella accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of NC and Blue Cross and Blue Shield of Oklahoma and 8 other insurers list John Kisella as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for John Kisella was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.