Diana Grace Mack, is a medicare enrolled "Marriage & Family Therapist" provider in Glendale, California. Her current practice location is
1540 E Colorado St, Glendale, California. You can reach out to her office (for appointments etc.) via phone at
(818) 244-7257.
Diana Grace Mack is licensed to practice in California (license number LCSW73928) 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 1174958409.
Healthcare Provider's Profile
| Full Name | Diana Grace Mack |
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| Gender | Female |
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| Speciality | Marriage & Family Therapist |
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| Location | 1540 E Colorado St, Glendale, 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: 1174958409
- Provider Enumeration Date: 09/05/2013
- Last Update Date: 12/03/2021
Medicare PECOS Information:
- PECOS PAC ID: 2365728052
- Enrollment ID: I20170412000673
Medical Identifiers
Medical identifiers for Diana Grace Mack such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1174958409 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1041C0700X | Social Worker - Clinical | LCSW 73928 (California) | Secondary |
| 225400000X | Rehabilitation Practitioner | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | LCSW73928 (California) | 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. Diana Grace Mack allows following entities to bill medicare on her behalf.
| Entity Name | Grow Healthcare Group Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1154994846
PECOS PAC ID: 1850774746
Enrollment ID: O20220809004080 |
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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. Diana Grace Mack 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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Diana Grace Mack,
4760 Sepulveda Blvd,
Culver City, CA 90230-4820
Ph: (310) 390-6612 | Diana Grace Mack,
1540 E Colorado St,
Glendale, CA 91205-1514
Ph: (818) 244-7257 |
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