Dr Matthew Clark, DDS, MD is a medicare enrolled "Dentist - Oral And Maxillofacial Surgery" provider in W Harrison, New York. His current practice location is
55 W Red Oak Ln, W Harrison, New York. You can reach out to his office (for appointments etc.) via phone at
(914) 500-8985.
Dr Matthew Clark is licensed to practice in New York (license number 057328) 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 1396905188.
Healthcare Provider's Profile
| Full Name | Dr Matthew Clark |
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| Gender | Male |
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| Speciality | Dentist - Oral And Maxillofacial Surgery |
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| Location | 55 W Red Oak Ln, W Harrison, 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. |
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NPI Data:
- NPI Number: 1396905188
- Provider Enumeration Date: 06/15/2008
- Last Update Date: 03/02/2022
Medicare PECOS Information:
- PECOS PAC ID: 8820316904
- Enrollment ID: I20150422000430
Medical Identifiers
Medical identifiers for Dr Matthew Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1396905188 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 057328 (New York) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 11099 (Connecticut) | Secondary |
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 Matthew Clark allows following entities to bill medicare on his behalf.
| Entity Name | Northeast Implant & Oral Surgery, Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215152574
PECOS PAC ID: 7012013790
Enrollment ID: O20070427000026 |
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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 Matthew Clark 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 Matthew Clark, DDS, MD
55 W Red Oak Ln,
W Harrison, NY 10604-3608
Ph: (914) 500-8985 | Dr Matthew Clark, DDS, MD
55 W Red Oak Ln,
W Harrison, NY 10604-3608
Ph: (914) 500-8985 |
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