Ms Jacquelyn Mae Block, MFT, LCSW, LMFT is a medicare enrolled "Social Worker - Clinical" provider in Fond Du Lac, Wisconsin. She graduated from healthcare school in 1990 and has 35 years of diverse experience with area of expertise as Clinical Social Worker. She is a member of the group practice Agnesian Healthcare Inc and her current practice location is
430 E Division St, Fond Du Lac, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(920) 926-4209.
Ms Jacquelyn Mae Block is licensed to practice in Wisconsin (license number 2841-123) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1336360429.
Healthcare Provider's Profile
| Full Name | Ms Jacquelyn Mae Block |
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| Gender | Female |
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| Speciality | Clinical Social Worker |
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| Experience | 35 Years |
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| Location | 430 E Division St, Fond Du Lac, Wisconsin |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Ms Jacquelyn Mae Block graduated from medical school in 1990
NPI Data:
- NPI Number: 1336360429
- Provider Enumeration Date: 05/02/2007
- Last Update Date: 12/16/2020
Medicare PECOS Information:
- PECOS PAC ID: 5890034771
- Enrollment ID: I20190312001399
Medical Identifiers
Medical identifiers for Ms Jacquelyn Mae Block such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1336360429 | NPI | - | NPPES |
| 226-124 | Other | WI | LMFT |
| 2841-123 | Other | WI | LCSW |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 106H00000X | Marriage & Family Therapist | 226-124 (Wisconsin) | Secondary |
| 1041C0700X | Social Worker - Clinical | 2841-123 (Wisconsin) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Agnesian Healthcare Inc | 1658289624 | 335 |
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. Ms Jacquelyn Mae Block allows following entities to bill medicare on her behalf.
| Entity Name | Agnesian Healthcare Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1346228541
PECOS PAC ID: 1658289624
Enrollment ID: O20031104000263 |
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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. Ms Jacquelyn Mae Block 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 |
|---|
Ms Jacquelyn Mae Block, MFT, LCSW, LMFT
420 E Division St,
Fond Du Lac, WI 54935-4560
Ph: (920) 926-4209 | Ms Jacquelyn Mae Block, MFT, LCSW, LMFT
430 E Division St,
Fond Du Lac, WI 54935-4560
Ph: (920) 926-4209 |
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