DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC
NPI 1053561779
Dentist - Oral and Maxillofacial Surgery in Huntington, WV
About Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DRS BROCK, HENDERSON, DI PRISCO, RAVELO AND GREEN INC (NPI 1053561779), doing business as Mt State Oral & Maxillofacial Surgeons, is a healthcare organization registered as an oral and maxillofacial surgery in Huntington, West Virginia and active in the NPI registry since September 2008. The organization lists Lesley Marie Coyner, Credentialing, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
12Medicare enrollment records show 12 clinicians reassign Medicare billing to Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc, which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians, nearest first (12)
Portsmouth, VA 23708
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 Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc's NPI number?
The NPI number for Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is 1053561779. It was assigned to this organization in the NPPES registry on September 30, 2008. The provider is doing business as Mt State Oral & Maxillofacial Surgeons.
Where is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc located?
Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is located at 3135 16th Street Rd Suite 20, Huntington, WV 25701. The listed phone number is (304) 399-1092.
What is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.
Is Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc enrolled in Medicare?
Yes. Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians, all in Oral Surgery, reassign their Medicare billing to Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc. 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.
What insurance does Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc accept?
Health plans from Highmark Blue Cross Blue Shield West Virginia list Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc was last updated on May 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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.
# Drs Brock, Henderson, Di Prisco, Ravelo And Green Inc · NPI 1053561779
Oral and Maxillofacial Surgery organization in Huntington, West Virginia. Organization record, active in the CMS NPPES registry since September 30, 2008.
## Identity
- **NPI:** 1053561779 (Entity type: Organization)
- **Enumerated:** September 30, 2008
- **Primary specialty:** Dentist - Oral and Maxillofacial Surgery · taxonomy 1223S0112X
- **Also known as:** Mt State Oral & Maxillofacial Surgeons (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Lesley Coyner, CREDENTIALING
## Practice location
- **Address:** 3135 16TH STREET RD, SUITE 20, Huntington, WV 25701
- **Phone:** (304) 399-1092
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 12 clinicians (Oral Surgery) reassign Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 29, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1053561779) · Data from the CMS NPPES public registry.