Nykenji Nicole Fogg, LCSW-C is a medicare enrolled "Social Worker - Clinical" provider in Churchton, Maryland. Her current practice location is
5881 Shady Side Rd, Churchton, Maryland. You can reach out to her office (for appointments etc.) via phone at
(443) 822-7273.
Nykenji Nicole Fogg is licensed to practice in Maryland (license number 20525) 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 1164192068.
Healthcare Provider's Profile
Full Name | Nykenji Nicole Fogg |
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Gender | Female |
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Speciality | Social Worker - Clinical |
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Location | 5881 Shady Side Rd, Churchton, Maryland |
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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: 1164192068
- Provider Enumeration Date: 09/14/2021
- Last Update Date: 09/14/2021
Medicare PECOS Information:
- PECOS PAC ID: 2365819216
- Enrollment ID: I20221104001813
Medical Identifiers
Medical identifiers for Nykenji Nicole Fogg such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1164192068 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
1041C0700X | Social Worker - Clinical | 20525 (Maryland) | 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. Nykenji Nicole Fogg allows following entities to bill medicare on her behalf.
Entity Name | Luminis Health Medical Group, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1649248485 PECOS PAC ID: 2860447315 Enrollment ID: O20080707000490 |
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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. Nykenji Nicole Fogg 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 |
Nykenji Nicole Fogg, LCSW-C Po Box 296, Edgewater, MD 21037-0296 Ph: (202) 446-6207 | Nykenji Nicole Fogg, LCSW-C 5881 Shady Side Rd, Churchton, MD 20733-9637 Ph: (443) 822-7273 |
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