Jack Alan Gift, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Harrisville, Utah. His current practice location is
313 W Concord Dr, Harrisville, Utah. You can reach out to his office (for appointments etc.) via phone at
(801) 814-7943.
Jack Alan Gift is licensed to practice in Utah (license number 7567279-3501) 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 1588969190.
Healthcare Provider's Profile
| Full Name | Jack Alan Gift |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 313 W Concord Dr, Harrisville, Utah |
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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: 1588969190
- Provider Enumeration Date: 01/13/2011
- Last Update Date: 07/11/2022
Medicare PECOS Information:
- PECOS PAC ID: 3274755194
- Enrollment ID: I20141110001093
Medical Identifiers
Medical identifiers for Jack Alan Gift such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1588969190 | NPI | - | NPPES |
| 7567279-3501 | Other | UT | LCSW LICENSE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 75672796005 (Utah) | Secondary |
| 104100000X | Social Worker | 7567279-3502 (Utah) | Secondary |
| 1041C0700X | Social Worker - Clinical | 7567279-3501 (Utah) | 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. Jack Alan Gift allows following entities to bill medicare on his behalf.
| Entity Name | Weber Human Services |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1043243140
PECOS PAC ID: 3274430244
Enrollment ID: O20031217000665 |
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| Entity Name | Lucid Lane Providers Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1912507021
PECOS PAC ID: 2163839382
Enrollment ID: O20220421001368 |
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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. Jack Alan Gift 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 |
|---|
Jack Alan Gift, LCSW
313 W Concord Dr,
Harrisville, UT 84404-2745
Ph: (801) 814-7943 | Jack Alan Gift, LCSW
313 W Concord Dr,
Harrisville, UT 84404-2745
Ph: (801) 814-7943 |
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