Jennifer Petell, PHD IN CLINICAL PSY is a medicare enrolled "Psychologist" provider in Southaven, Mississippi. Her current practice location is
5908 Getwell Rd, Southaven, Mississippi. You can reach out to her office (for appointments etc.) via phone at
(901) 536-4646.
Jennifer Petell is licensed to practice in Mississippi (license number 641185) 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 1710505268.
Healthcare Provider's Profile
| Full Name | Jennifer Petell |
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| Gender | Female |
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| Speciality | Psychologist |
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| Location | 5908 Getwell Rd, Southaven, Mississippi |
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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: 1710505268
- Provider Enumeration Date: 07/10/2020
- Last Update Date: 11/21/2024
Medicare PECOS Information:
- PECOS PAC ID: 7416493838
- Enrollment ID: I20240722003603
Medical Identifiers
Medical identifiers for Jennifer Petell such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1710505268 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | 4107 (Tennessee) | Secondary |
| 103T00000X | Psychologist | 641185 (Mississippi) | 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. Jennifer Petell allows following entities to bill medicare on her behalf.
| Entity Name | Primary Care Group, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1093016651
PECOS PAC ID: 0941480131
Enrollment ID: O20110920000312 |
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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. Jennifer Petell 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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Jennifer Petell, PHD IN CLINICAL PSY
1211 Union Ave Ste 330,
Memphis, TN 38104-6655
Ph: () - | Jennifer Petell, PHD IN CLINICAL PSY
5908 Getwell Rd,
Southaven, MS 38672-7317
Ph: (901) 536-4646 |
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