Jesse David Malott, is a medicare enrolled "Psychologist" provider in Memphis, Tennessee. His current practice location is
2861 Broad Ave, Memphis, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(901) 701-2520.
Jesse David Malott is licensed to practice in Tennessee (license number ) 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 1659651487.
Healthcare Provider's Profile
| Full Name | Jesse David Malott |
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| Gender | Male |
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| Speciality | Psychologist |
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| Location | 2861 Broad Ave, Memphis, Tennessee |
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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: 1659651487
- Provider Enumeration Date: 08/24/2011
- Last Update Date: 08/29/2016
Medicare PECOS Information:
- PECOS PAC ID: 9537455167
- Enrollment ID: I20160908001454
Medical Identifiers
Medical identifiers for Jesse David Malott such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1659651487 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (Tennessee) | 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. Jesse David Malott allows following entities to bill medicare on his behalf.
| Entity Name | Christ Community Health Services Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1982686614
PECOS PAC ID: 3870402084
Enrollment ID: O20040528000468 |
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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. Jesse David Malott 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 |
|---|
Jesse David Malott,
1020 S Arroyo Pkwy,
Pasadena, CA 91105-3911
Ph: () - | Jesse David Malott,
2861 Broad Ave,
Memphis, TN 38112-2903
Ph: (901) 701-2520 |
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