Jaime Gunderson, LCSW, CSAC is a medicare enrolled "Social Worker" provider in Mayville, Wisconsin. Her current practice location is
1446 Horicon St, Mayville, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(920) 539-0219.
Jaime Gunderson is licensed to practice in Wisconsin (license number 131568-121) 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 1164955878.
Healthcare Provider's Profile
| Full Name | Jaime Gunderson |
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| Gender | Female |
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| Speciality | Social Worker |
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| Location | 1446 Horicon St, Mayville, Wisconsin |
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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: 1164955878
- Provider Enumeration Date: 04/10/2017
- Last Update Date: 10/23/2022
Medicare PECOS Information:
- PECOS PAC ID: 5092109652
- Enrollment ID: I20220224000317
Medical Identifiers
Medical identifiers for Jaime Gunderson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1164955878 | NPI | - | NPPES |
| 1164955878 | Medicaid | WI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1041C0700X | Social Worker - Clinical | 9826-123 (Wisconsin) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 16566-132 (Wisconsin) | Secondary |
| 104100000X | Social Worker | 131568-121 (Wisconsin) | 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. Jaime Gunderson allows following entities to bill medicare on her behalf.
| Entity Name | Kettle Moraine Counseling Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1568790954
PECOS PAC ID: 8527353747
Enrollment ID: O20200416001123 |
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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. Jaime Gunderson 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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Jaime Gunderson, LCSW, CSAC
710 N Milwaukee St,
Theresa, WI 53091-9716
Ph: (920) 539-0219 | Jaime Gunderson, LCSW, CSAC
1446 Horicon St,
Mayville, WI 53050-1467
Ph: (920) 539-0219 |
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