Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Registered Nurse - Diabetes Educator |
|---|
| Location | 5750 Baum Blvd Ste 306, Pittsburgh, Pennsylvania |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1063025302
- Provider Enumeration Date: 08/26/2020
- Last Update Date: 02/15/2023
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1063025302 | NPI | - | NPPES |
| 1038862390002 | Medicaid | PA | |
| 1038862390001 | Medicaid | PA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 133V00000X | Dietitian, Registered | (* (Not Available)) | Secondary |
| 163WD0400X | Registered Nurse - Diabetes Educator | (* (Not Available)) | Primary |
| 174H00000X | Health Educator | (* (Not Available)) | Secondary |
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. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
5750 Baum Blvd Ste 306,
Pittsburgh, PA 15206-3793
Ph: (412) 593-2048 |
5750 Baum Blvd Ste 306,
Pittsburgh, PA 15206-3793
Ph: (412) 593-2048 |
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