Dr Jaclyn Renee Derosso, AUD is a medicare enrolled "Audiologist" provider in Reseda, California. Her current practice location is
18040 Sherman Way, Reseda, California. You can reach out to her office (for appointments etc.) via phone at
(503) 997-4669.
Dr Jaclyn Renee Derosso is licensed to practice in Oregon (license number 30928) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1184186447.
Healthcare Provider's Profile
| Full Name | Dr Jaclyn Renee Derosso |
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| Gender | Female |
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| Speciality | Audiologist |
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| Location | 18040 Sherman Way, Reseda, California |
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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: 1184186447
- Provider Enumeration Date: 04/04/2019
- Last Update Date: 10/13/2020
Medicare PECOS Information:
- PECOS PAC ID: 2668700964
- Enrollment ID: I20190823003504
Medical Identifiers
Medical identifiers for Dr Jaclyn Renee Derosso such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1184186447 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 231H00000X | Audiologist | 30928 (Oregon) | Primary |
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 Jaclyn Renee Derosso allows following entities to bill medicare on her behalf.
| Provider Name | Providence Health & Services Oregon |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1023488343
PECOS PAC ID: 0648183608
Enrollment ID: O20031106000652 |
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| Provider Name | Providence Health & Services Oregon |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1366536963
PECOS PAC ID: 6103728753
Enrollment ID: O20040123000371 |
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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 Jaclyn Renee Derosso 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 Jaclyn Renee Derosso, AUD
5309 Sw Multnomah Blvd,
Portland, OR 97219-3345
Ph: (541) 979-2344 | Dr Jaclyn Renee Derosso, AUD
18040 Sherman Way,
Reseda, CA 91335-4631
Ph: (503) 997-4669 |
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