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DR. MITCHELL DOUGLAS DUCKWORTH DDS
NPI 1649530601
Student in an Organized Health Care Education/Training Program in Stony Brook, NY

Active since May 24, 2012PECOS Enrolled
STONY BROOK UNIVERSITY HOSPITAL DEPT OF, STONY BROOK, NY 11794(631) 444-2557(631) 444-6013 Get Directions Write a Review

NPPES record last updated: May 19, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Dr. Mitchell Douglas Duckworth Dds NPPES

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

DR. MITCHELL DOUGLAS DUCKWORTH DDS (NPI 1649530601) is an individual student in an organized health care education/training program in Stony Brook, New York and active in the NPI registry since May 2012. He is enrolled in Medicare PECOS and maintains a secondary practice location in Holladay.

NPPES Registry Identity

NPI1649530601
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. MITCHELL DOUGLAS DUCKWORTHCredential: DDS
Location AddressSTONY BROOK UNIVERSITY HOSPITAL DEPT OFStony Brook, NY 11794-8711
Mailing Address5136 S Cottonwood LnHolladay, UT 84117-7102 · (801) 718-6395
Phone(631) 444-2557
Fax(631) 444-6013
Sole ProprietorNo
Enumeration DateMay 24, 2012
Last NPPES UpdateMay 19, 2025
NPPES CertifiedMay 19, 2025
✔ NPI 1649530601 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Also ListedDentist · Dentist AnesthesiologistTaxonomy 1223D0004X · License 8926334-9924 (UT)
STONY BROOK UNIVERSITY HOSPITAL DEPT OF, Stony Brook, NY 11794
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Secondary Practice Location 1

Location 15136 S Cottonwood LnHolladay, UT 84117-7102 · Phone (801) 718-6395

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Mitchell Douglas Duckworth Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mitchell Duckworth reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Family Surgical Suite
2,017 mi
Ambulatory Surgical
151 E 5600 S STE 104
Murray, UT 84107
  • Reassigned Medicare billing, Utah enrollment
  • 15 clinicians in this Medicare group
NPI 1083861165 (801) 495-1064

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 Mitchell Duckworth's NPI number?

The NPI number for Mitchell Duckworth is 1649530601. It was assigned to this individual provider in the NPPES registry on May 24, 2012.

Where is Mitchell Duckworth located?

Mitchell Duckworth practices at Stony Brook University Hospital Dept Of, Stony Brook, NY 11794. The listed phone number is (631) 444-2557.

What is Mitchell Duckworth's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Mitchell Duckworth enrolled in Medicare?

Yes. Mitchell Duckworth is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mitchell Duckworth's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mitchell Duckworth reassigns Medicare benefits to Family Surgical Suite (Murray, UT). The 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 Mitchell Duckworth's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mitchell Duckworth accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Florida Combined Life and 3 other insurers list Mitchell Duckworth 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 Mitchell Duckworth was last updated on May 19, 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.