Jonathan Michael Dubos, is a medicare enrolled "Psychologist - Clinical Child & Adolescent" provider in San Rafael, California. His current practice location is
111 Smith Ranch Rd, San Rafael, California. You can reach out to his office (for appointments etc.) via phone at
(415) 491-3000.
Jonathan Michael Dubos is licensed to practice in California (license number PSY33913) 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 1174930085.
Healthcare Provider's Profile
| Full Name | Jonathan Michael Dubos |
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| Gender | Male |
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| Speciality | Psychologist - Clinical Child & Adolescent |
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| Location | 111 Smith Ranch Rd, San Rafael, California |
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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: 1174930085
- Provider Enumeration Date: 07/14/2014
- Last Update Date: 04/10/2023
Medicare PECOS Information:
- PECOS PAC ID: 3870958820
- Enrollment ID: I20230427000753
Medical Identifiers
Medical identifiers for Jonathan Michael Dubos such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1174930085 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 172V00000X | Community Health Worker | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | PSY33913 (California) | 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. Jonathan Michael Dubos allows following entities to bill medicare on his behalf.
| Entity Name | Permanente Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1073606299
PECOS PAC ID: 8921910225
Enrollment ID: O20031104000710 |
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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. Jonathan Michael Dubos 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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Jonathan Michael Dubos,
524 Reliant Way,
American Canyon, CA 94503-3239
Ph: (310) 966-7767 | Jonathan Michael Dubos,
111 Smith Ranch Rd,
San Rafael, CA 94903-1939
Ph: (415) 491-3000 |
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