Jack Formanek, MS, LMHP in Council Bluffs, IA

Jack Formanek, MS, LMHP is a medicare enrolled "Counselor - Mental Health" provider in Council Bluffs, Iowa. His current practice location is 307 E View Dr, Council Bluffs, Iowa. You can reach out to his office (for appointments etc.) via phone at (712) 325-1584.

Jack Formanek is licensed to practice in Iowa (license number 205) 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 1285791376.

Contact Information

	Jack Formanek, MS, LMHP
	307 E View Dr, Council Bluffs, IA 51503-0464
	(712) 325-1584
	(712) 325-0546

Map and Direction

Healthcare Provider's Profile

Full Name	Jack Formanek
Gender	Male
Speciality	Counselor - Mental Health
Location	307 E View Dr, Council Bluffs, Iowa
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1285791376
Provider Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007

Medicare PECOS Information:

PECOS PAC ID: 6709226186
Enrollment ID: I20240502000945

Medical Identifiers

Medical identifiers for Jack Formanek such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1285791376	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YM0800X	Counselor - Mental Health	205 (Iowa)	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 Formanek allows following entities to bill medicare on his behalf.

Entity Name	Charles Drew Health Center Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1255302170 PECOS PAC ID: 9830170653 Enrollment ID: O20040527000621

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 Formanek 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 Formanek, MS, LMHP 307 E View Dr, Council Bluffs, IA 51503-0464 Ph: (712) 325-1584	Jack Formanek, MS, LMHP 307 E View Dr, Council Bluffs, IA 51503-0464 Ph: (712) 325-1584

Reviews and Comments

Counselor in Council Bluffs, IA

Monica S Meier, PMHP, PMSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 515 E. Broadway, Council Bluffs, IA 51503 Phone: 712-322-1407 Fax: 712-322-6833
Ashley Peregrine, Counselor Medicare: Not Enrolled in Medicare Practice Location: 2912 9th Ave, Council Bluffs, IA 51501 Phone: 402-553-3000
Jennifer Stewart, Counselor Medicare: Not Enrolled in Medicare Practice Location: 515 E Broadway, Council Bluffs, IA 51503 Phone: 712-322-1407 Fax: 712-322-6833
Mrs. Rachelle A Bartlett, MS, PLMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 803 3rd Ave, Council Bluffs, IA 51501 Phone: 712-352-0917
Thomas Edward Koch, MS Counselor Medicare: Not Enrolled in Medicare Practice Location: 803 3rd Ave # Ia51501, Council Bluffs, IA 51501 Phone: 712-352-0917 Fax: 712-352-0837
Robert Scott Andrews, MS LMHC NCC Counselor Medicare: Medicare Enrolled Practice Location: 300 W Broadway Ste 107, Council Bluffs, IA 51503 Phone: 712-328-3700
Mrs. Carolyn Ann Andersen Burgher, MS LMHC LMHP LIMHP Counselor Medicare: Not Enrolled in Medicare Practice Location: 35 Main Place, Suite 100 Omni Center Business Park, Council Bluffs, IA 51503 Phone: 712-320-9205

Jack Formanek, MS, LMHP - Medicare Counselor in Council Bluffs, IA