Mark Nissenbaum, DMD MDC FCDSA OMFS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

8460 Issued in MA

Practice address

200 Boylston St
Suite 305
Chestnut Hill, MA 02467-2012

Phone

(617) 731-8888

Fax

(617) 731-3107

NPI assigned

Nov 4, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jeffrey C. Sacks DMD Ms PCGroup PAC ID 7517014673, 3 clinicians

Chestnut Hill Oral Surgery LLCGroup PAC ID 9739654500, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Chestnut Hill Oral Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Chestnut Hill, MA
  • NPI 1639046469
  Medicare reassignment Care Compare group NPD
• Jeffrey C. Sacks DMD Ms PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Chestnut Hill, MA
  • NPI 1649301805
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393459200000",
    "number": "1902897184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BOYLSTON ST",
            "address_2": "SUITE 305",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "024672012",
            "telephone_number": "617-731-8888",
            "fax_number": "617-731-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BOYLSTON ST",
            "address_2": "SUITE 305",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "024672012",
            "telephone_number": "617-731-8888",
            "fax_number": "617-731-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSENBAUM",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DMD MDC FCDSA OMFS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2014-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MA",
            "license": "8460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Betty Bet-Ling NG, MD
• Steven Louis Nickman, MD
• Amanda Marie Nicoles, ATC, LAT
• Saritha Nitin
• Amelia Nodell, PT, DPT
• Anne E Norris, PHD, RNCS
• Danielle Nugent, PT, DPT
• NVP Medical Group Ca, P.C

• Oral & Maxillofacial Surgery (D.M.D.) in Chestnut Hill, MA
• Providers in Chestnut Hill, MA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.