Dr Mitchell Douglas Duckworth, DDS is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in Stony Brook, New York. His current practice location is
Stony Brook University Hospital Dept Of, Stony Brook, New York. You can reach out to his office (for appointments etc.) via phone at
(631) 444-2557.
Dr Mitchell Douglas Duckworth is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1649530601.
Healthcare Provider's Profile
| Full Name | Dr Mitchell Douglas Duckworth |
|---|
| Gender | Male |
|---|
| Speciality | Student In An Organized Health Care Education/training Program |
|---|
| Location | Stony Brook University Hospital Dept Of, Stony Brook, New York |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1649530601
- Provider Enumeration Date: 05/24/2012
- Last Update Date: 05/19/2025
Medicare PECOS Information:
- PECOS PAC ID: 6608205554
- Enrollment ID: I20231016001517
Medical Identifiers
Medical identifiers for Dr Mitchell Douglas Duckworth such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1649530601 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223D0004X | Dentist - Dentist Anesthesiologist | 8926334-9924 (Utah) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Mitchell Douglas Duckworth allows following entities to bill medicare on his behalf.
| Entity Name | Family Surgical Suite |
|---|
| Entity Type | Part B Supplier - Ambulatory Surgical Center |
|---|
| Entity Identifiers | NPI Number: 1508040221
PECOS PAC ID: 6901989003
Enrollment ID: O20080213000228 |
|---|
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mitchell Douglas Duckworth is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Mitchell Douglas Duckworth, DDS
5136 S Cottonwood Ln,
Holladay, UT 84117-7102
Ph: (801) 718-6395 | Dr Mitchell Douglas Duckworth, DDS
Stony Brook University Hospital Dept Of,
Stony Brook, NY 11794-8711
Ph: (631) 444-2557 |
Reviews and Comments