Shontiaya S Patterson, FNP is a medicare enrolled "Nurse Practitioner - Family" provider in Riverdale, Georgia. Her current practice location is
1324 Highway 138 Sw, Riverdale, Georgia. You can reach out to her office (for appointments etc.) via phone at
(770) 907-4949.
Shontiaya S Patterson is licensed to practice in Georgia (license number RN219785) 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 1063762870.
Healthcare Provider's Profile
| Full Name | Shontiaya S Patterson |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 1324 Highway 138 Sw, Riverdale, Georgia |
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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: 1063762870
- Provider Enumeration Date: 09/19/2012
- Last Update Date: 12/03/2020
Medicare PECOS Information:
- PECOS PAC ID: 5698189801
- Enrollment ID: I20210129001627
Medical Identifiers
Medical identifiers for Shontiaya S Patterson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1063762870 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | RN219785 (Georgia) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | RN219785 (Georgia) | 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. Shontiaya S Patterson allows following entities to bill medicare on her behalf.
| Entity Name | Caedel Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1710922075
PECOS PAC ID: 0648258988
Enrollment ID: O20040712001450 |
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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. Shontiaya S Patterson 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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Shontiaya S Patterson, FNP
141 Watkins Glen Dr,
Mcdonough, GA 30252-4061
Ph: (770) 309-8302 | Shontiaya S Patterson, FNP
1324 Highway 138 Sw,
Riverdale, GA 30296-1404
Ph: (770) 907-4949 |
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