Mr William Tiva Bounthong, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Loves Park, Illinois. His current practice location is
7399 Forest Hills Rd, Loves Park, Illinois. You can reach out to his office (for appointments etc.) via phone at
(815) 708-7392.
Mr William Tiva Bounthong is licensed to practice in Illinois (license number 149025844) 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 1144091505.
Healthcare Provider's Profile
| Full Name | Mr William Tiva Bounthong |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 7399 Forest Hills Rd, Loves Park, Illinois |
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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: 1144091505
- Provider Enumeration Date: 01/12/2024
- Last Update Date: 02/22/2024
Medicare PECOS Information:
- PECOS PAC ID: 5799124459
- Enrollment ID: I20240415003239
Medical Identifiers
Medical identifiers for Mr William Tiva Bounthong such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1144091505 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | 149025844 (Illinois) | Secondary |
| 1041C0700X | Social Worker - Clinical | 149025844 (Illinois) | 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 William Tiva Bounthong allows following entities to bill medicare on his behalf.
| Entity Name | Restore Counseling & Recovery Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1588909923
PECOS PAC ID: 0446497598
Enrollment ID: O20130508000321 |
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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 William Tiva Bounthong 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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Mr William Tiva Bounthong, LCSW
7399 Forest Hills Rd,
Loves Park, IL 61111-3974
Ph: (815) 708-7392 | Mr William Tiva Bounthong, LCSW
7399 Forest Hills Rd,
Loves Park, IL 61111-3974
Ph: (815) 708-7392 |
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