CHAMPAIGN ORAL SURGERY CENTER
NPI 1669540399
Dentist - Oral and Maxillofacial Surgery in Champaign, IL

Q: What is Central Illinois Oral And Maxillofacial Surgery, PC's specialty?

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

Active since December 01, 2006

14 E ANTHONY DR, SUITE C, CHAMPAIGN, IL 61820(217) 355-2809(217) 355-5921 Get Directions Write a Review

NPPES record last updated: August 23, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Champaign Oral Surgery Center NPPES

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

CHAMPAIGN ORAL SURGERY CENTER (NPI 1669540399) is a healthcare organization registered as an oral and maxillofacial surgery in Champaign, Illinois and active in the NPI registry since December 2006. The organization lists Amy M Kroeger, Insurance Coordinator, as its authorized official.

NPPES Registry Identity

NPI1669540399

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameCENTRAL ILLINOIS ORAL AND MAXILLOFACIAL SURGERY, PC

Location Address14 E ANTHONY DR, SUITE CChampaign, IL 61820-2748

Mailing Address14 E Anthony Dr, Suite CChampaign, IL 61820-2748 · (217) 355-2809 · Fax (217) 355-5921

Phone(217) 355-2809

Fax(217) 355-5921

Organization SubpartYes

Authorized OfficialAmy M KroegerInsurance Coordinator · (217) 540-5100

Enumeration DateDecember 1, 2006

Last NPPES UpdateAugust 23, 2023

NPPES CertifiedAugust 23, 2023

✔ NPI 1669540399 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

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.

14 E ANTHONY DR, Champaign, IL 61820

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Other Names 1

Doing Business AsChampaign Oral Surgery Center

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Champaign Oral Surgery Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Champaign Oral Surgery Center, which bills Medicare for the services this clinician delivers.

Clinician (1)

Thomas Fonner, DMD

Maxillofacial Surgery

NPI 1205907581

100 GREENVIEW DR STE B
Effingham, IL 62401

(217) 540-5348

✔ PECOS✔ Accepts Medicare71 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Central Illinois Oral And Maxillofacial Surgery, PC's NPI number?

The NPI number for Central Illinois Oral And Maxillofacial Surgery, PC is 1669540399. It was assigned to this organization in the NPPES registry on December 1, 2006. The provider is doing business as Champaign Oral Surgery Center.

Where is Central Illinois Oral And Maxillofacial Surgery, PC located?

Central Illinois Oral And Maxillofacial Surgery, PC is located at 14 E Anthony Dr Suite C, Champaign, IL 61820. The listed phone number is (217) 355-2809.

What is Central Illinois Oral And Maxillofacial Surgery, PC's specialty?

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

Is Central Illinois Oral And Maxillofacial Surgery, PC enrolled in Medicare?

Yes. Central Illinois Oral And Maxillofacial Surgery, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Central Illinois Oral And Maxillofacial Surgery, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Maxillofacial Surgery) reassigns their Medicare billing to Central Illinois Oral And Maxillofacial Surgery, 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Central Illinois Oral And Maxillofacial Surgery, PC was last updated on August 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.