Mr Mario Lippy, PSYCHOLOGIST is a medicare enrolled "Psychologist" provider in Prescott, Arizona. His current practice location is
990 Willow Creek Rd, Prescott, Arizona. You can reach out to his office (for appointments etc.) via phone at
(877) 634-7333.
Mr Mario Lippy is licensed to practice in Arizona (license number PSY004234) 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 1750453106.
Healthcare Provider's Profile
| Full Name | Mr Mario Lippy |
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| Gender | Male |
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| Speciality | Psychologist |
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| Location | 990 Willow Creek Rd, Prescott, Arizona |
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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: 1750453106
- Provider Enumeration Date: 11/14/2006
- Last Update Date: 07/23/2021
Medicare PECOS Information:
- PECOS PAC ID: 2668876210
- Enrollment ID: I20210804003130
Medical Identifiers
Medical identifiers for Mr Mario Lippy such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1750453106 | NPI | - | NPPES |
| PSY004234 | Other | AZ | ARIZONA STATE BOARD OF PSYCHOLOGIST EXAMINERS |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | LISAC11042 (Arizona) | Secondary |
| 103T00000X | Psychologist | PSY004234 (Arizona) | 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. Mr Mario Lippy allows following entities to bill medicare on his behalf.
| Entity Name | Spectrum Healthcare Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1487635389
PECOS PAC ID: 3072411388
Enrollment ID: O20031223000698 |
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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. Mr Mario Lippy 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 |
|---|
Mr Mario Lippy, PSYCHOLOGIST
8 E Cottonwood St,
Cottonwood, AZ 86326-4382
Ph: (877) 634-7333 | Mr Mario Lippy, PSYCHOLOGIST
990 Willow Creek Rd,
Prescott, AZ 86301-1640
Ph: (877) 634-7333 |
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