Shane K Davis, LMHC is a medicare enrolled "Psychologist - Counseling" provider in Bradenton, Florida. His current practice location is
4515 26th St W, Bradenton, Florida. You can reach out to his office (for appointments etc.) via phone at
(269) 282-4298.
Shane K Davis is licensed to practice in Michigan (license number 6361001470) 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 1689822686.
Healthcare Provider's Profile
| Full Name | Shane K Davis |
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| Gender | Male |
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| Speciality | Psychologist - Counseling |
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| Location | 4515 26th St W, Bradenton, 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: 1689822686
- Provider Enumeration Date: 09/03/2008
- Last Update Date: 10/17/2024
Medicare PECOS Information:
- PECOS PAC ID: 4880038637
- Enrollment ID: I20240220002322
Medical Identifiers
Medical identifiers for Shane K Davis such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1689822686 | NPI | - | NPPES |
| 6301013040 | Other | MI | LICENSE |
| 6361001470 | Other | MI | LIMITED LICENSE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | MH23035 (Florida) | Secondary |
| 103TC1900X | Psychologist - Counseling | 6361001470 (Michigan) | 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. Shane K Davis allows following entities to bill medicare on his behalf.
| Entity Name | Mindful Mental Health Services - Fl Gulf Sw Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1568121267
PECOS PAC ID: 9234523325
Enrollment ID: O20220307001924 |
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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. Shane K Davis 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 |
|---|
Shane K Davis, LMHC
4515 26th St W,
Bradenton, FL 34207-7200
Ph: (269) 282-4298 | Shane K Davis, LMHC
4515 26th St W,
Bradenton, FL 34207-7200
Ph: (269) 282-4298 |
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