Elizabeth G Gamboa-reynolds, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Kenosha, Wisconsin. Her current practice location is
2108 63rd St, Kenosha, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(262) 652-2406.
Elizabeth G Gamboa-reynolds is licensed to practice in Wisconsin (license number 9880) 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 1689255291.
Healthcare Provider's Profile
| Full Name | Elizabeth G Gamboa-reynolds |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 2108 63rd St, Kenosha, 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: 1689255291
- Provider Enumeration Date: 04/15/2021
- Last Update Date: 02/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 3971999616
- Enrollment ID: I20220406001914
Medical Identifiers
Medical identifiers for Elizabeth G Gamboa-reynolds such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1689255291 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | 131302121 (Wisconsin) | Secondary |
| 1041C0700X | Social Worker - Clinical | 9880 (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. Elizabeth G Gamboa-reynolds allows following entities to bill medicare on her behalf.
| Entity Name | Professional Services Group Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1619024262
PECOS PAC ID: 8224296454
Enrollment ID: O20120220000742 |
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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. Elizabeth G Gamboa-reynolds 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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Elizabeth G Gamboa-reynolds, LCSW
6233 39th Ave,
Kenosha, WI 53142-7015
Ph: (262) 654-1004 | Elizabeth G Gamboa-reynolds, LCSW
2108 63rd St,
Kenosha, WI 53143-4454
Ph: (262) 652-2406 |
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