Dr Jack Dwosh, MD is a medicare enrolled "Urology" physician in Mt. Laurel, New Jersey. His current practice location is
15000 Midlantic Drive, Suite 100, Mt. Laurel, New Jersey. You can reach out to his office (for appointments etc.) via phone at
(856) 252-1000.
Dr Jack Dwosh is licensed to practice in New Jersey (license number 25MA04771800) 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 1033180724.
Physician's Profile
| Full Name | Dr Jack Dwosh |
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| Gender | Male |
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| Speciality | Urology |
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| Location | 15000 Midlantic Drive, Mt. Laurel, New Jersey |
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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: 1033180724
- Provider Enumeration Date: 01/30/2006
- Last Update Date: 06/23/2021
Medicare PECOS Information:
- PECOS PAC ID: 2163408881
- Enrollment ID: I20060206000452
Medical Identifiers
Medical identifiers for Dr Jack Dwosh such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1033180724 | NPI | - | NPPES |
| 0055472 | Other | | AETNA |
| 0073781000 | Other | | AMERIHEALTH |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208800000X | Urology | MD064953L (Pennsylvania) | Secondary |
| 208800000X | Urology | 25MA04771800 (New Jersey) | 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. Dr Jack Dwosh allows following entities to bill medicare on his behalf.
| Entity Name | New Jersey Urology Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1588822423
PECOS PAC ID: 1456410638
Enrollment ID: O20081103000206 |
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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. Dr Jack Dwosh 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 |
|---|
Dr Jack Dwosh, MD
15000 Midlantic Dr, Suite 100,
Mount Laurel, NJ 08054-1573
Ph: (856) 252-1000 | Dr Jack Dwosh, MD
15000 Midlantic Drive, Suite 100,
Mt. Laurel, NJ 08054
Ph: (856) 252-1000 |
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