Pukan Phaoudom, in Fresno, CA - Medicare Social Worker Provider

Pukan Phaoudom, is a medicare enrolled "Social Worker - Clinical" provider in Fresno, California. His current practice location is 4447 E. Cesar Chavez Blvd, Fresno, California. You can reach out to his office (for appointments etc.) via phone at (559) 600-4693.

Pukan Phaoudom is licensed to practice in California (license number LCSW25857) 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 1790844512.

Contact Information

	Pukan Phaoudom,
	4447 E. Cesar Chavez Blvd, Fresno, CA 93702-3604
	(559) 600-4693
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Pukan Phaoudom
Gender	Male
Speciality	Social Worker - Clinical
Location	4447 E. Cesar Chavez Blvd, Fresno, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1790844512
Provider Enumeration Date: 12/07/2006
Last Update Date: 09/17/2024

Medicare PECOS Information:

PECOS PAC ID: 5799096160
Enrollment ID: I20150625002735

Medical Identifiers

Medical identifiers for Pukan Phaoudom such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1790844512	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1041C0700X	Social Worker - Clinical	(* (Not Available))	Secondary
1041C0700X	Social Worker - Clinical	LCSW25857 (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. Pukan Phaoudom allows following entities to bill medicare on his behalf.

Entity Name	County Of Fresno
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1770538001 PECOS PAC ID: 4981591690 Enrollment ID: O20040227000935

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. Pukan Phaoudom 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
Pukan Phaoudom, 4447 E. Cesar Chavez Blvd, Fresno, CA 93702-3604 Ph: (559) 600-4693	Pukan Phaoudom, 4447 E. Cesar Chavez Blvd, Fresno, CA 93702-3604 Ph: (559) 600-4693

Reviews and Comments

Social Worker in Fresno, CA

Jodi Marr, AA Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1350 M St, Fresno, CA 93721 Phone: 559-457-3940
Mrs. Stephanie Ann Cocci, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2615 E Clinton Ave, Building 12-hchv, Fresno, CA 93703 Phone: 559-351-0459
Mrs. Allyson Jennifer Torres, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1156 W Escalon Ave, Fresno, CA 93711 Phone: 559-210-4525
Samantha Oleson, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 677 E Roberts Ave, Fresno, CA 93710 Phone: 559-355-7207
Ms. Lynn Lirette, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 5740 N Palm, #105, Fresno, CA 93704 Phone: 559-224-8419 Fax: 559-431-1951
Ms. Irene Alice Aparicio, MS, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2109 W Bullard Ave, Suite 145, Fresno, CA 93711 Phone: 559-439-1534
Ms. Johanna Carroll, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1600 M St, Fresno, CA 93721 Phone: 559-237-4706

Pukan Phaoudom, - Medicare Clinical Social Worker in Fresno, CA