NPIMap

Individual provider Active NPI

Mark Goodenough, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Staten Island, NY
National Provider Identifier
1154858033
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
063143 Issued in NY
Practice address
256C Mason Ave
Staten Island, NY 10305-3408
Phone
(718) 226-1251
NPI assigned
May 22, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 063143 NY Primary
General Practice Physician 208D00000X 311698 NY

Addresses

Primary practice location

256C Mason Ave
Staten Island, NY 10305-3408

Mailing address

256 Mason Ave # C
Staten Island, NY 10305-3408
Phone (718) 226-1251

Other practice location 1

1441 South Ave Ste 707
Staten Island, NY 10314-3784
Phone (718) 226-1251

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230929001677 NY Practitioner - Oral Surgery 6800240433 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Columbia University College of Dental Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Staten Island Oral and Maxillofacial SurgeryGroup PAC ID 4486821709, 4 clinicians

Practice addresses (Care Compare)

256 C Mason Ave
Staten Island, NY 10305-1942

256 C Mason Ave 3Rd FL
Staten Island, NY 10305-1942
Phone (718) 226-1251

256 Mason Ave
C
Staten Island, NY 10305-3408

Hospital & facility affiliations

  • Geisinger Medical Center Hospital, Danville, PA, CCN 390006
  • Maimonides Medical Center Hospital, Brooklyn, NY, CCN 330194

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
063143NYMDOral & Maxillofacial Surgery (D.M.D.)

Practice roles

OrganizationSpecialtyStatusNew patients
Staten Island Oral & Maxillofacial Surgery CurrentSince Aug 2, 2023 Accepting new patients

Locations

1441 South Ave
Ste 707
Staten Island, NY 10314
Phone (718) 226-1251

256 Mason Ave
#C
Staten Island, NY 10305
Phone (718) 226-1251

256 Mason Ave
Fl 3
Staten Island, NY 10305
Phone (718) 226-1251

Interoperability endpoints

  • Direct secure messaging: mgoodenough51480@northwell.direct-ci.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1154858033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 MASON AVE # C",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053408",
            "telephone_number": "718-226-1251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256C MASON AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053408",
            "telephone_number": "718-226-1251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1441 South Ave Ste 707",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103143784",
            "country_code": "US",
            "telephone_number": "718-226-1251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODENOUGH",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-22",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NY",
            "license": "063143",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "311698",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.