Bryson Dale Blackburn, LCSW is a medicare enrolled "Counselor - Mental Health" provider in Arcadia, Florida. His current practice location is
725 N 12th Ave, Arcadia, Florida. You can reach out to his office (for appointments etc.) via phone at
(863) 494-1242.
Bryson Dale Blackburn is licensed to practice in Florida (license number SW14904) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1891208393.
Healthcare Provider's Profile
| Full Name | Bryson Dale Blackburn |
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| Gender | Male |
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| Speciality | Counselor - Mental Health |
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| Location | 725 N 12th Ave, Arcadia, Florida |
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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: 1891208393
- Provider Enumeration Date: 11/07/2017
- Last Update Date: 07/21/2023
Medicare PECOS Information:
- PECOS PAC ID: 3971862418
- Enrollment ID: I20180109001646
Medical Identifiers
Medical identifiers for Bryson Dale Blackburn such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1891208393 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1041C0700X | Social Worker - Clinical | SW14904 (Florida) | Secondary |
| 101YM0800X | Counselor - Mental Health | SW14904 (Florida) | 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. Bryson Dale Blackburn allows following entities to bill medicare on his behalf.
| Entity Name | Mcr Health Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1255376000
PECOS PAC ID: 7214847995
Enrollment ID: O20040126000213 |
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| Entity Name | Refresh Canopy Cove, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1730661752
PECOS PAC ID: 3779822119
Enrollment ID: O20190304000354 |
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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. Bryson Dale Blackburn 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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Bryson Dale Blackburn, LCSW
700 8th Ave W Ste 101,
Palmetto, FL 34221-4737
Ph: (941) 776-4000 | Bryson Dale Blackburn, LCSW
725 N 12th Ave,
Arcadia, FL 34266-8752
Ph: (863) 494-1242 |
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