NPIMap

Individual provider Active NPI

Mark J Dibenedetto, M.D.

  • Internal Medicine Physician
  • Port Jefferson, NY
National Provider Identifier
1619940269
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
172308 Issued in NY
Practice address
710 Main St
Port Jefferson, NY 11777-2223
Phone
(631) 474-4000
Fax
(631) 474-4011
NPI assigned
Feb 13, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 172308 NY Primary

Addresses

Primary practice location

710 Main St
Port Jefferson, NY 11777-2223

Mailing address

710 Main St
Port Jefferson, NY 11777-2223
Phone (631) 474-4000

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
I20101221000143 NY Practitioner - Internal Medicine 9638367410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of New York Downstate Medical Center, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

710 Main St
Port Jefferson, NY 11777-2278
Phone (631) 474-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
20.11 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
67.03

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
172308NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Village Internal Medicine Group Internal Medicine CurrentSince Nov 4, 1988 Accepting new patients

Locations

710 Main St
Prt Jefferson, NY 11777
Phone (631) 680-7222

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619940269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 MAIN ST",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772223",
            "telephone_number": "631-474-4000",
            "fax_number": "631-474-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 MAIN ST",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772223",
            "telephone_number": "631-474-4000",
            "fax_number": "631-474-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBENEDETTO",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "172308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.