San Thawalanthanne, is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" provider in Longwood, Florida. His current practice location is
2290 N Ronald Reagan Blvd Ste 116, Longwood, Florida. You can reach out to his office (for appointments etc.) via phone at
(407) 215-0095.
San Thawalanthanne is licensed to practice in Florida (license number 11031100) 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 1275397622.
Healthcare Provider's Profile
| Full Name | San Thawalanthanne |
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| Gender | Male |
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| Speciality | Nurse Practitioner - Psychiatric/mental Health |
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| Location | 2290 N Ronald Reagan Blvd Ste 116, Longwood, Florida |
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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: 1275397622
- Provider Enumeration Date: 02/07/2024
- Last Update Date: 11/04/2024
Medicare PECOS Information:
- PECOS PAC ID: 7618418484
- Enrollment ID: I20240919002730
Medical Identifiers
Medical identifiers for San Thawalanthanne such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1275397622 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 11031100 (Florida) | 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. San Thawalanthanne allows following entities to bill medicare on his behalf.
| Entity Name | Impower, Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1104910868
PECOS PAC ID: 6507924883
Enrollment ID: O20081015000736 |
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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. San Thawalanthanne 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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San Thawalanthanne,
1000 S Lake Dr,
Clearwater, FL 33756-4415
Ph: (815) 451-2897 | San Thawalanthanne,
2290 N Ronald Reagan Blvd Ste 116,
Longwood, FL 32750-3534
Ph: (407) 215-0095 |
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