NPIMap

Individual provider Active NPI

Mark Todd Godenick, MD

  • Family Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1467405845
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14616 Issued in SC
Practice address
853 N Church St
Suite 510
Spartanburg, SC 29303-3098
Phone
(864) 560-6193
Fax
(864) 560-1510
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14616 SC Primary

Addresses

Primary practice location

853 N Church St
Suite 510
Spartanburg, SC 29303-3098

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other identifiers 6

IdentifierTypeStateIssuer
AA96196067OtherSCMEDICARE PIN
A723895019OtherSCMEDICARE PIN
4455408OtherSCAETNA
A723893365OtherSCMEDICARE PIN
D6334OtherSCMEDCOST
TL3829MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgodenick37010@direct-srhs.et0939.epichosted.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20031231000379 SC Practitioner - Family Practice 4082513833 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, shared by 17 NPIs, 1,060 clinicians

Practice addresses (Care Compare)

151 Peachwood Centre Dr
Spartanburg, SC 29301-2575
Phone (864) 560-9627

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Family Medicine CurrentSince Aug 1, 2004 Accepting new patients
Spartanburg Medical Center CurrentSince Aug 1, 2004 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Apr 1, 2007 Accepting new patients
Spartanburg Hospital for Restorative Care Family Medicine Past Accepting new patients
Spartanburg Medical Center Past Accepting new patients
Spartanburg Medical Center Past Accepting new patients

Locations

702 S Alabama Ave
Chesnee, SC 29323
Phone (864) 703-1414

101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554

853 N Church St
Ste 510
Spartanburg, SC 29303
Phone (864) 560-1558

389 Serpentine Dr
Spartanburg, SC 29303
Phone (864) 560-3263

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

2660 Reidville Rd
Unit 1
Spartanburg, SC 29301
Phone (864) 560-9696

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

151 Peachwood Centre Dr
Spartanburg, SC 29301
Phone (864) 560-9627

Organizations & group practices 8

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1467405845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 N CHURCH ST",
            "address_2": "SUITE 510",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033098",
            "telephone_number": "864-560-6193",
            "fax_number": "864-560-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODENICK",
        "first_name": "MARK",
        "middle_name": "TODD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "14616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "AA96196067",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "A723895019",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4455408",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "A723893365",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "D6334",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TL3829",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgodenick37010@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mgodenick37010@direct-srhs.et0939.epichosted.com",
            "address_1": "853 N Church St",
            "address_2": "Suite 510",
            "city": "Spartanburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293033098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.