Ivy Petra, LCSW, LCAC is a medicare enrolled "Social Worker - Clinical" provider in Goshen, Indiana. Her current practice location is
213 Middlebury St, Goshen, Indiana. You can reach out to her office (for appointments etc.) via phone at
(574) 534-3300.
Ivy Petra is licensed to practice in Indiana (license number 34006676A) 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 1538592704.
Healthcare Provider's Profile
| Full Name | Ivy Petra |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 213 Middlebury St, Goshen, Indiana |
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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: 1538592704
- Provider Enumeration Date: 08/12/2013
- Last Update Date: 12/31/2020
Medicare PECOS Information:
- PECOS PAC ID: 8628203999
- Enrollment ID: I20131023001331
Medical Identifiers
Medical identifiers for Ivy Petra such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1538592704 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 87001243A (Indiana) | Secondary |
| 1041C0700X | Social Worker - Clinical | 34006676A (Indiana) | 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. Ivy Petra allows following entities to bill medicare on her behalf.
| Entity Name | Maple City Health Care Center Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1033166095
PECOS PAC ID: 2163569401
Enrollment ID: O20110615000145 |
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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. Ivy Petra 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 |
|---|
Ivy Petra, LCSW, LCAC
213 Middlebury St,
Goshen, IN 46528-2956
Ph: (574) 534-3300 | Ivy Petra, LCSW, LCAC
213 Middlebury St,
Goshen, IN 46528
Ph: (574) 534-3300 |
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