Jacqueline Marie Wyman, MS, RD, LD in Phoenix, AZ - Medicare Dietitian, Registered Provider

Jacqueline Marie Wyman, MS, RD, LD is a medicare enrolled "Dietitian, Registered" provider in Phoenix, Arizona. Her current practice location is 1919 E Thomas Rd, Phoenix, Arizona. You can reach out to her office (for appointments etc.) via phone at (602) 933-0940.

Jacqueline Marie Wyman is licensed to practice in Arizona (license number 86066765) 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 1073073045.

Contact Information

	Jacqueline Marie Wyman, MS, RD, LD
	1919 E Thomas Rd, Phoenix, AZ 85016-7710
	(602) 933-0940
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Jacqueline Marie Wyman
Gender	Female
Speciality	Dietitian, Registered
Location	1919 E Thomas Rd, Phoenix, Arizona
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1073073045
Provider Enumeration Date: 03/25/2019
Last Update Date: 06/22/2022

Medicare PECOS Information:

PECOS PAC ID: 4880922020
Enrollment ID: I20220503000155

Medical Identifiers

Medical identifiers for Jacqueline Marie Wyman such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1073073045	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
133V00000X	Dietitian, Registered	86066765 (Arizona)	Primary
133V00000X	Dietitian, Registered	LD.08638 (Ohio)	Secondary

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. Jacqueline Marie Wyman allows following entities to bill medicare on her behalf.

Provider Name	Phoenix Children's Hospital
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1922112044 PECOS PAC ID: 0446278584 Enrollment ID: O20051107000704

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. Jacqueline Marie Wyman 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
Jacqueline Marie Wyman, MS, RD, LD 2108 E Thomas Rd Ste 130, Phoenix, AZ 85016-7761 Ph: (602) 933-3124	Jacqueline Marie Wyman, MS, RD, LD 1919 E Thomas Rd, Phoenix, AZ 85016-7710 Ph: (602) 933-0940

Reviews and Comments

Dietitian, Registered in Phoenix, AZ

Mrs. Maria T Escobar, CSP, RD Dietitian Medicare: Medicare Enrolled Practice Location: 1919 E Thomas Rd, Phoenix, AZ 85016 Phone: 480-440-2787
Jennie Altman, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 635 E Baseline Rd, Phoenix, AZ 85042 Phone: 602-243-7277 Fax: 602-243-1235
Mrs. Danielle Lafata, R.D. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 3509 N 32nd St, Phoenix, AZ 85018 Phone: 480-399-7246
Laura Grace Simmons, MS, RDN, CD Dietitian Medicare: Accepting Medicare Assignments Practice Location: 2713 W Pecan Rd, Phoenix, AZ 85041 Phone: 253-470-8399 Fax: 866-540-3225
Miss Erika Josephine Barrera, RDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 16601 N 12th St Apt 1142, Phoenix, AZ 85022 Phone: 520-425-9698
Melanie Shay Colville, MS, RD Dietitian Medicare: Medicare Enrolled Practice Location: 222 W Thomas Rd, Suite 304, Phoenix, AZ 85013 Phone: 602-406-3611 Fax: 602-406-4363
Laura Lee, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 635 E Baseline Rd, Phoenix, AZ 85042 Phone: 602-243-7277 Fax: 602-243-1235

Jacqueline Marie Wyman, MS, RD, LD - Medicare Dietitian in Phoenix, AZ