Brandon Eugene Fornwalt, in Glendale, AZ

Brandon Eugene Fornwalt, is a medicare enrolled "Otolaryngology" physician in Glendale, Arizona. His current practice location is 18699 N 67th Ave Ste 300, Glendale, Arizona. You can reach out to his office (for appointments etc.) via phone at (623) 566-4718.

Brandon Eugene Fornwalt is licensed to practice in Arizona (license number 009926) 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 1912407172.

Contact Information

	Brandon Eugene Fornwalt,
	18699 N 67th Ave Ste 300, Glendale, AZ 85308-7149
	(623) 566-4718
	(523) 566-4820

Map and Direction

Physician's Profile

Full Name	Brandon Eugene Fornwalt
Gender	Male
Speciality	Otolaryngology
Location	18699 N 67th Ave Ste 300, Glendale, Arizona
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1912407172
Provider Enumeration Date: 02/14/2018
Last Update Date: 07/03/2023

Medicare PECOS Information:

PECOS PAC ID: 9133477748
Enrollment ID: I20230713003148

Medical Identifiers

Medical identifiers for Brandon Eugene Fornwalt such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1912407172	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Y00000X	Otolaryngology	009926 (Arizona)	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. Brandon Eugene Fornwalt allows following entities to bill medicare on his behalf.

Entity Name	Valley Ent Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1508990185 PECOS PAC ID: 8729149711 Enrollment ID: O20120202000209

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. Brandon Eugene Fornwalt 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
Brandon Eugene Fornwalt, 9097 E Desert Cove Ave Ste 200, Scottsdale, AZ 85260-6280 Ph: (928) 614-7516	Brandon Eugene Fornwalt, 18699 N 67th Ave Ste 300, Glendale, AZ 85308-7149 Ph: (623) 566-4718

Reviews and Comments

Otolaryngology Doctors in Glendale, AZ

Dr. David L Simms, M.D. Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 5750 W. Thunderbird Rd, Suite A-100, Glendale, AZ 85306 Phone: 602-938-3205 Fax: 602-938-5799
Dr. Gordon E Chait, M.D. Otolaryngology Medicare: Not Enrolled in Medicare Practice Location: 5750 W Thunderbird Rd, Ste. A-100, Glendale, AZ 85306 Phone: 602-938-3205 Fax: 602-938-5799
Sudhir P Agarwal, MD Otolaryngology Medicare: Not Enrolled in Medicare Practice Location: 5757 W Thunderbird Road, Suite W301, Glendale, AZ 85306 Phone: 602-938-3777 Fax: 602-547-0379
Elliot Martin Libling, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 18700 N 64th Dr, Ste 312, Glendale, AZ 85308 Phone: 623-566-4718 Fax: 623-566-4820
Michael Rodriguez, D.O. Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 20325 N 51st Ave Ste 154, Glendale, AZ 85308 Phone: 623-900-4740 Fax: 855-398-9290
Ravi P Agarwal, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 5757 W Thunderbird Rd, Suite W301, Glendale, AZ 85306 Phone: 602-938-3777 Fax: 602-547-0379
Stephanie Diana Warrington, MD Otolaryngology Medicare: Medicare Enrolled Practice Location: 5750 W Thunderbird Rd Ste A100, Glendale, AZ 85306 Phone: 602-938-3205 Fax: 602-938-5799

Brandon Eugene Fornwalt, - Medicare Otolaryngology in Glendale, AZ