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VILLAGE INTERNAL MEDICINE GROUP
NPI 1003889023
Internal Medicine in Port Jefferson, NY

Active since February 09, 2006
710 MAIN STREET, PORT JEFFERSON, NY 11777(631) 474-4000(631) 474-4011 Get Directions Write a Review

NPPES record last updated: December 29, 2010. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Village Internal Medicine Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VILLAGE INTERNAL MEDICINE GROUP (NPI 1003889023) is a healthcare organization registered as an internal medicine in Port Jefferson, New York and active in the NPI registry since February 2006. The organization lists Mark J. Dibenedetto, Md/president, as its authorized official.

NPPES Registry Identity

NPI1003889023
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameVILLAGE INTERNAL MEDICINE GROUP
Location Address710 MAIN STREETPort Jefferson, NY 11777
Mailing Address710 Main Street, Village Internal Medicine GroupPort Jefferson, NY 11777 · (631) 474-4000 · Fax (631) 474-4011
Phone(631) 474-4000
Fax(631) 474-4011
Organization SubpartNo
Authorized OfficialMark J. DibenedettoMd/president · (631) 474-4000
Enumeration DateFebruary 9, 2006
Last NPPES UpdateDecember 29, 2010
✔ NPI 1003889023 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in NY · 172308
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
710 MAIN STREET, Port Jefferson, NY 11777
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Village Internal Medicine Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by January 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateNew YorkEnrollment IDO20120524000191Non-DME Part B · Clinic/Group PracticeDue dateJanuary 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Village Internal Medicine Group, which bills Medicare for the services this clinician delivers.

Clinician (1)

Mark Dibenedetto, M.D.
Internal Medicine
NPI 1619940269
710 MAIN ST
Port Jefferson, NY 11777
(631) 474-4000
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Village Internal Medicine Group's NPI number?

The NPI number for Village Internal Medicine Group is 1003889023. It was assigned to this organization in the NPPES registry on February 9, 2006.

Where is Village Internal Medicine Group located?

Village Internal Medicine Group is located at 710 Main Street, Port Jefferson, NY 11777. The listed phone number is (631) 474-4000.

What is Village Internal Medicine Group's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Village Internal Medicine Group enrolled in Medicare?

Yes. Village Internal Medicine Group is registered in the Medicare PECOS enrollment system.

When is Village Internal Medicine Group's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New York, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Village Internal Medicine Group?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Village Internal Medicine Group. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Village Internal Medicine Group was last updated on December 29, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.