Thomas Shane Bolan, LCSW, CSAC is a medicare enrolled "Social Worker - Clinical" provider in Middleton, Wisconsin. His current practice location is
3207 Laura Ln Ste 100, Middleton, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(608) 290-0956.
Thomas Shane Bolan is licensed to practice in Wisconsin (license number 8420-123) 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 1770703431.
Healthcare Provider's Profile
| Full Name | Thomas Shane Bolan |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 3207 Laura Ln Ste 100, Middleton, Wisconsin |
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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: 1770703431
- Provider Enumeration Date: 04/26/2007
- Last Update Date: 04/01/2024
Medicare PECOS Information:
- PECOS PAC ID: 3577932656
- Enrollment ID: I20221212002505
Medical Identifiers
Medical identifiers for Thomas Shane Bolan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1770703431 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 15382-132 (Wisconsin) | Secondary |
| 101YM0800X | Counselor - Mental Health | 8420-123 (Wisconsin) | Secondary |
| 1041C0700X | Social Worker - Clinical | 8420-123 (Wisconsin) | 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. Thomas Shane Bolan allows following entities to bill medicare on his behalf.
| Entity Name | Hanna Medical Clinic Sc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1902342868
PECOS PAC ID: 6901182955
Enrollment ID: O20170406000676 |
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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. Thomas Shane Bolan 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 |
|---|
Thomas Shane Bolan, LCSW, CSAC
3207 Laura Ln Ste 120,
Middleton, WI 53562-1428
Ph: (608) 752-2930 | Thomas Shane Bolan, LCSW, CSAC
3207 Laura Ln Ste 100,
Middleton, WI 53562-1428
Ph: (608) 290-0956 |
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