Western Reserve Nutrition is a medicare enrolled "Dietitian, Registered" provider in Streetsboro, Ohio. Their current practice location is
9205 State Route 43 Ste 106, Streetsboro, Ohio. You can reach out to their office (for appointments etc.) via phone at
(330) 554-9327.
Western Reserve Nutrition is licensed to practice in Ohio (license number 4344) and it also participates in the medicare program. Western Reserve Nutrition
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1356883474.
Healthcare Provider's Profile
| Full Name | Western Reserve Nutrition |
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| Type | Facility |
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| Speciality | Dietitian, Registered |
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| Location | 9205 State Route 43 Ste 106, Streetsboro, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1356883474
- Provider Enumeration Date: 11/07/2016
- Last Update Date: 11/12/2020
Medicare PECOS Information:
- PECOS PAC ID: 5698185650
- Enrollment ID: O20201102001859
Medical Identifiers
Medical identifiers for Western Reserve Nutrition such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1356883474 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133V00000X | Dietitian, Registered | 4344 (Ohio) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Western Reserve Nutrition acts as a billing entity for following providers:
| Provider Name | Carolyn Joseph Bouquot |
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| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
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| Provider Identifiers | NPI Number: 1922208198
PECOS PAC ID: 9830285717
Enrollment ID: I20071024000094 |
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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. Western Reserve Nutrition 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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Western Reserve Nutrition
5757 Bradford Way,
Hudson, OH 44236-3901
Ph: (330) 554-9327 | Western Reserve Nutrition
9205 State Route 43 Ste 106,
Streetsboro, OH 44241-5366
Ph: (330) 554-9327 |
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