Dr Sullivan Clyde Hanback, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Houston, Texas. His current practice location is
6431 Fannin Street, Suite Jjl 270-6, Houston, Texas. You can reach out to his office (for appointments etc.) via phone at
(713) 500-7878.
Dr Sullivan Clyde Hanback is licensed to practice in * (Not Available) (license number ) 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 1417538141.
Physician's Profile
| Full Name | Dr Sullivan Clyde Hanback |
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| Gender | Male |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 6431 Fannin Street, Houston, Texas |
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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: 1417538141
- Provider Enumeration Date: 04/15/2021
- Last Update Date: 06/30/2023
Medicare PECOS Information:
- PECOS PAC ID: 0941647259
- Enrollment ID: I20240322000301
Medical Identifiers
Medical identifiers for Dr Sullivan Clyde Hanback such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1417538141 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207P00000X | Emergency Medicine | U4523 (Texas) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | 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 Sullivan Clyde Hanback allows following entities to bill medicare on his behalf.
| Entity Name | Temple Faculty Practice Plan Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1881176949
PECOS PAC ID: 0345588711
Enrollment ID: O20190208002623 |
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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 Sullivan Clyde Hanback 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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Dr Sullivan Clyde Hanback, MD
6431 Fannin Street, Suite Jjl 270-6,
Houston, TX 77030
Ph: (713) 500-7878 | Dr Sullivan Clyde Hanback, MD
6431 Fannin Street, Suite Jjl 270-6,
Houston, TX 77030
Ph: (713) 500-7878 |
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