Brian Ullom, is a medicare enrolled "Pediatrics" physician in Wapato, Washington. His current practice location is
620 W 1st St, Wapato, Washington. You can reach out to his office (for appointments etc.) via phone at
(509) 877-4111.
Brian Ullom is licensed to practice in Washington (license number MD00032635) 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 1508952797.
Physician's Profile
| Full Name | Brian Ullom |
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| Gender | Male |
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| Speciality | Pediatrics |
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| Location | 620 W 1st St, Wapato, Washington |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1508952797
- Provider Enumeration Date: 10/05/2006
- Last Update Date: 03/24/2021
Medicare PECOS Information:
- PECOS PAC ID: 6608267042
- Enrollment ID: I20211220001821
Medical Identifiers
Medical identifiers for Brian Ullom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1508952797 | NPI | - | NPPES |
| 8180184 | Medicaid | WA | |
| UL4310 | Other | WA | REGENCE |
| 6730 | Other | | GROUP HEALTH |
| 911019392 | Other | | COMMERCIAL |
| 8180184 | Other | WA | CHPW |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | MD00032635 (Washington) | 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. Brian Ullom allows following entities to bill medicare on his behalf.
| Entity Name | Yakima Valley Farm Workers Clinic |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1295788602
PECOS PAC ID: 4385541986
Enrollment ID: O20040211000663 |
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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. Brian Ullom 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 |
|---|
Brian Ullom,
620 W 1st St,
Wapato, WA 98951-1108
Ph: (509) 877-4111 | Brian Ullom,
620 W 1st St,
Wapato, WA 98951-1108
Ph: (509) 877-4111 |
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