Dr Mark Goodenough, DDS is a medicare enrolled "Oral & Maxillofacial Surgery" physician in Staten Island, New York. His current practice location is
256c Mason Ave, Staten Island, New York. You can reach out to his office (for appointments etc.) via phone at
(718) 226-1251.
Dr Mark Goodenough is licensed to practice in New York (license number 063143) 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 1154858033.
Physician's Profile
Full Name | Dr Mark Goodenough |
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Gender | Male |
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Speciality | Oral & Maxillofacial Surgery |
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Location | 256c Mason Ave, Staten Island, New York |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1154858033
- Provider Enumeration Date: 05/22/2017
- Last Update Date: 12/06/2023
Medicare PECOS Information:
- PECOS PAC ID: 6800240433
- Enrollment ID: I20230929001677
Medical Identifiers
Medical identifiers for Dr Mark Goodenough such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1154858033 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208D00000X | General Practice | 311698 (New York) | Secondary |
204E00000X | Oral & Maxillofacial Surgery | 063143 (New York) | 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 Mark Goodenough allows following entities to bill medicare on his behalf.
Entity Name | Staten Island Oral & Maxillofacial Surgery |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1316217763 PECOS PAC ID: 4486821709 Enrollment ID: O20120126000740 |
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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 Mark Goodenough 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 Mark Goodenough, DDS 256 Mason Ave # C, Staten Island, NY 10305-3408 Ph: (718) 226-1251 | Dr Mark Goodenough, DDS 256c Mason Ave, Staten Island, NY 10305-3408 Ph: (718) 226-1251 |
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