Dr Leslie M Dally, DO is a medicare enrolled "Preventive Medicine - Addiction Medicine" physician in Lebanon, Tennessee. He went to Kansas City College Of Medicine And Surgery and graduated in 2002 and has 23 years of diverse experience with area of expertise as Addiction Medicine. He is a member of the group practice Impact Healthcare, Pllc and his current practice location is
1405 W Baddour Pkwy Ste 101, Lebanon, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(615) 994-1288.
Dr Leslie M Dally is licensed to practice in Tennessee (license number 4418) and he also participates in the medicare program. He
may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1306093877.
Physician's Profile
| Full Name | Dr Leslie M Dally |
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| Gender | Male |
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| Speciality | Addiction Medicine |
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| Experience | 23 Years |
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| Location | 1405 W Baddour Pkwy Ste 101, Lebanon, Tennessee |
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| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Leslie M Dally attended and graduated from Kansas City College Of Medicine And Surgery in 2002
NPI Data:
- NPI Number: 1306093877
- Provider Enumeration Date: 08/26/2008
- Last Update Date: 07/28/2021
Medicare PECOS Information:
- PECOS PAC ID: 0244399160
- Enrollment ID: I20210809000372
Medical Identifiers
Medical identifiers for Dr Leslie M Dally such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1306093877 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 4418 (Tennessee) | Secondary |
| 2083A0300X | Preventive Medicine - Addiction Medicine | 4418 (Tennessee) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Impact Healthcare, Pllc | 5991065427 | 10 |
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 Leslie M Dally allows following entities to bill medicare on his behalf.
| Entity Name | Impact Healthcare, Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1487185153
PECOS PAC ID: 5991065427
Enrollment ID: O20180201001424 |
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| Entity Name | Cedar Recovery Of Middle Tennessee, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1801345285
PECOS PAC ID: 0446671440
Enrollment ID: O20200529001321 |
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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 Leslie M Dally 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 Leslie M Dally, DO
5000 Crossings Cir Ste 103,
Mount Juliet, TN 37122-8591
Ph: (615) 680-0110 | Dr Leslie M Dally, DO
1405 W Baddour Pkwy Ste 101,
Lebanon, TN 37087-2595
Ph: (615) 994-1288 |
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