Back To Health Of Branford, Llc is a medicare enrolled "Internal Medicine" provider in Branford, Connecticut. Their current practice location is
400 West Main Street, Branford, Connecticut. You can reach out to their office (for appointments etc.) via phone at
(203) 483-7778.
Back To Health Of Branford, Llc is licensed to practice in Connecticut (license number 037255) and it also participates in the medicare program. Back To Health Of Branford, Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1215958772.
Healthcare Provider's Profile
| Full Name | Back To Health Of Branford, Llc |
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| Type | Facility |
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| Speciality | Internal Medicine |
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| Location | 400 West Main Street, Branford, Connecticut |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1215958772
- Provider Enumeration Date: 07/21/2006
- Last Update Date: 12/22/2014
Medicare PECOS Information:
- PECOS PAC ID: 9739155045
- Enrollment ID: O20040908001006
Medical Identifiers
Medical identifiers for Back To Health Of Branford, Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1215958772 | NPI | - | NPPES |
| 07D1072612 | Other | CT | CLIA WAIVER |
| C02868 | Other | | GROUP |
| 008038901 | Medicaid | CT | |
| 008038939 | Medicaid | CT | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 111N00000X | Chiropractor | 148 (Connecticut) | Secondary |
| 111N00000X | Chiropractor | 001614 (Connecticut) | Secondary |
| 111NI0900X | Chiropractor - Internist | 000561 (Connecticut) | Secondary |
| 207R00000X | Internal Medicine | 037255 (Connecticut) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 037255 (Connecticut) | Secondary |
| 335E00000X | Prosthetic/orthotic Supplier | 037255 (Connecticut) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 002765 (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.
Back To Health Of Branford, Llc acts as a billing entity for following providers:
| Provider Name | Patrice M Wilhelm |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1225011778
PECOS PAC ID: 2466403811
Enrollment ID: I20050203000184 |
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| Provider Name | Michael S Wong |
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| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
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| Provider Identifiers | NPI Number: 1346226834
PECOS PAC ID: 1759304819
Enrollment ID: I20060104000750 |
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| Provider Name | Michael Russo |
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| Provider Type | Practitioner - Chiropractic |
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| Provider Identifiers | NPI Number: 1891762837
PECOS PAC ID: 6709852015
Enrollment ID: I20110411000731 |
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| Provider Name | Kristi V Maynard |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1821344037
PECOS PAC ID: 6204088867
Enrollment ID: I20121205000091 |
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| Provider Name | Lesley N Charles |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1376940635
PECOS PAC ID: 3971827593
Enrollment ID: I20150130000165 |
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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. Back To Health Of Branford, Llc 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 |
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Back To Health Of Branford, Llc
400 W Main St,
Branford, CT 06405-3416
Ph: (203) 483-7778 | Back To Health Of Branford, Llc
400 West Main Street,
Branford, CT 06405
Ph: (203) 483-7778 |
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