Kimberly Back, LISW-S is a medicare enrolled "Social Worker - Clinical" provider in Fairfield, Ohio. Her current practice location is
6570 Sosna Dr Ste 2, Fairfield, Ohio. You can reach out to her office (for appointments etc.) via phone at
(513) 942-4673.
Kimberly Back is licensed to practice in Ohio (license number I.1451413) 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 1578923181.
Healthcare Provider's Profile
| Full Name | Kimberly Back |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 6570 Sosna Dr Ste 2, Fairfield, Ohio |
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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: 1578923181
- Provider Enumeration Date: 02/25/2016
- Last Update Date: 10/30/2023
Medicare PECOS Information:
- PECOS PAC ID: 6507156601
- Enrollment ID: I20160601002814
Medical Identifiers
Medical identifiers for Kimberly Back such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1578923181 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | LICDC.161918 (Ohio) | Secondary |
| 1041C0700X | Social Worker - Clinical | I.1451413 (Ohio) | 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. Kimberly Back allows following entities to bill medicare on her behalf.
| Entity Name | Decoach Team Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1366992224
PECOS PAC ID: 7517244551
Enrollment ID: O20170501001472 |
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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. Kimberly Back 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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Kimberly Back, LISW-S
100 Crowne Point Pl,
Cincinnati, OH 45241-5427
Ph: (513) 743-7628 | Kimberly Back, LISW-S
6570 Sosna Dr Ste 2,
Fairfield, OH 45014-2222
Ph: (513) 942-4673 |
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