Gina M Zupan, ACMHC is a medicare enrolled "Counselor - Mental Health" provider in Provo, Utah. Her current practice location is
750 N Freedom Blvd, Provo, Utah. You can reach out to her office (for appointments etc.) via phone at
(801) 373-4760.
Gina M Zupan is licensed to practice in Utah (license number 11508440-6009) 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 1205470366.
Healthcare Provider's Profile
Full Name | Gina M Zupan |
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Gender | Female |
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Speciality | Counselor - Mental Health |
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Location | 750 N Freedom Blvd, Provo, Utah |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1205470366
- Provider Enumeration Date: 11/01/2019
- Last Update Date: 12/07/2023
Medicare PECOS Information:
- PECOS PAC ID: 5496105595
- Enrollment ID: I20240102003578
Medical Identifiers
Medical identifiers for Gina M Zupan such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1205470366 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
1041C0700X | Social Worker - Clinical | 11508440-6009 (Utah) | Secondary |
101YM0800X | Counselor - Mental Health | 11508440-6009 (Utah) | 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. Gina M Zupan allows following entities to bill medicare on her behalf.
Entity Name | Wasatch Behavioral Health Special Service District |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1356357115 PECOS PAC ID: 2567367915 Enrollment ID: O20031129000014 |
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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. Gina M Zupan 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 |
Gina M Zupan, ACMHC 750 N Freedom Blvd, Provo, UT 84601-1677 Ph: (801) 373-4760 | Gina M Zupan, ACMHC 750 N Freedom Blvd, Provo, UT 84601-1677 Ph: (801) 373-4760 |
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