DR. ANGELA MICHELLE ILLUZZI-RUSSO DDS
NPI 1811041726
Dentist - Oral and Maxillofacial Surgery in Portland, ME

Q: What is Angela Illuzzi-russo's NPI number?

The NPI number for Angela Illuzzi-russo is 1811041726. It was assigned to this individual provider in the NPPES registry on January 22, 2007.

Q: What is Angela Illuzzi-russo's specialty?

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

Q: Is Angela Illuzzi-russo enrolled in Medicare?

No. Angela Illuzzi-russo has opted out of Medicare through January 1, 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.

Active since January 22, 2007Opted out of Medicare · through Jan 1, 2027

190 PARK AVE, PORTLAND, ME 04102(207) 874-1028 Get Directions Write a Review

NPPES record last updated: February 4, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 4, 2021, Jun 27, 2016 (2 updates tracked since 2016).

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About Dr. Angela Michelle Illuzzi-russo Dds NPPES

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

DR. ANGELA MICHELLE ILLUZZI-RUSSO DDS (NPI 1811041726) is an individual oral and maxillofacial surgery provider in Portland, Maine, licensed in Maine (DEN4836) and active in the NPI registry since January 2007. She has opted out of Medicare through January 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1811041726

Entity TypeIndividualFemale

Primary Taxonomy1223S0112X

Provider Legal NameDR. ANGELA MICHELLE ILLUZZI-RUSSOCredential: DDS

Location Address190 PARK AVEPortland, ME 04102-1000

Mailing Address10 Lone Pine LnYarmouth, ME 04096-6119 · (917) 502-0030

Phone(207) 874-1028

Sole ProprietorYes

Enumeration DateJanuary 22, 2007

Last NPPES UpdateFebruary 4, 20212 updates tracked since enumeration

NPPES CertifiedFebruary 4, 2021

✔ NPI 1811041726 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

Licenses✔ Licensed in ME · DEN4836✔ Licensed in NY · 052809✔ Licensed in NJ · 22DI02347100

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.

190 PARK AVE, Portland, ME 04102

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Accepted Insurance

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Angela Michelle Illuzzi-russo Dds 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 January 1, 2025 through January 1, 2027.

Opt-Out Effective DateJanuary 1, 2025

Opt-Out In Effect ThroughJanuary 1, 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 04102 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

$86.72 typical visit price

range $56.28 – $169.96

Typical copayment $21.68 (range $14.07 – $42.49)

Most-billed visit code 99203

Established Patient

$70.13 typical visit price

range $18.22 – $138.92

Typical copayment $17.53 (range $4.55 – $34.73)

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 14

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

FRANCHESCA ROLSHUD DMD

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