Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Jack Capodice Jr., MD, DMD

Individual provider Oral and Maxillofacial Surgery (Dentist) · NPI 1053397612

Dr. Jack Capodice Jr., MD, DMD is an Oral Surgery in Bloomington, Illinois. Graduated from University of Missouri, Columbia School of Medicine in 1990, 36 years ago. Practices with Capodice Efaw Ocheltree and Elger PLLC, a 5-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
36
Trained at
University of Missouri, Columbia School of Medicine
Licensed in
IL
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

109 N Regency Dr
Bloomington, IL 61701-3515
Phone: (309) 663-2526
Fax: (309) 663-4788
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 019022744 (IL)

Record details

NPI number1053397612
Entity typeIndividual (Type 1)
GenderMale
Credentials MD , DMD
Sole proprietorNo
NPI enumeratedDecember 15, 2005
Last updated in NPPESApril 6, 2026
Certification dateApril 6, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyORAL SURGERY
Also practisesMAXILLOFACIAL SURGERY
Medical schoolUNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Graduated 1990 (36 years in practice)
Group practice Capodice Efaw Ocheltree And Elger Pllc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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