DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
NPI 1447711858
Dentist - Oral and Maxillofacial Surgery in Charleston, WV
About Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC (NPI 1447711858), doing business as Mt State Oral & Facial Surgery, is a healthcare organization registered as an oral and maxillofacial surgery in Charleston, West Virginia and active in the NPI registry since March 2019. The organization holds a CLIA Waiver certificate valid through July 15, 2027 and lists Lesley Marie Coyner, Credentialing, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
12Medicare enrollment records show 12 clinicians reassign Medicare billing to Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 3 within 10 miles. They are listed nearest first.
Clinicians, nearest first (12)
Portsmouth, VA 23708
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 51D2169104
Drs Brock Henderson, Diprisco, Ravelo & Green · Charleston, WVFrequently 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 Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc's NPI number?
The NPI number for Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is 1447711858. It was assigned to this organization in the NPPES registry on March 28, 2019. The provider is doing business as Mt State Oral & Facial Surgery.
Where is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc located?
Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is located at 4307 Maccorkle Ave SE, Charleston, WV 25304. The listed phone number is (304) 345-1092.
What is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.
Is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc enrolled in Medicare?
Yes. Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians, all in Oral Surgery, reassign their Medicare billing to Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc. 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. Of these, 1 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 51D2169104) is associated with this NPI, valid through July 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc accept?
Health plans from Highmark Blue Cross Blue Shield West Virginia and UnitedHealthcare list Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc 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 Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc was last updated on May 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc · NPI 1447711858
Oral and Maxillofacial Surgery organization in Charleston, West Virginia. Organization record, active in the CMS NPPES registry since March 28, 2019.
## Identity
- **NPI:** 1447711858 (Entity type: Organization)
- **Enumerated:** March 28, 2019
- **Primary specialty:** Dentist - Oral and Maxillofacial Surgery · taxonomy 1223S0112X
- **Also known as:** Mt State Oral & Facial Surgery (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Lesley Coyner, CREDENTIALING
## Practice location
- **Address:** 4307 MACCORKLE AVE SE, Charleston, WV 25304-2500
- **Phone:** (304) 345-1092
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 12 clinicians (Oral Surgery) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 30, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1447711858) · Data from the CMS NPPES public registry.