Everett Roy Forman, MD is a medicare enrolled "General Practice" physician in Latham, New York. He went to Albany Medical College Of Union University and graduated in 1968 and has 56 years of diverse experience with area of expertise as General Practice. His current practice location is
585 Troy Schenectady Rd, Latham, New York. You can reach out to his office (for appointments etc.) via phone at
(518) 785-6004.
Everett Roy Forman is licensed to practice in New York (license number 103928-1) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1528061967.
Physician's Profile
| Full Name | Everett Roy Forman |
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| Gender | Male |
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| Speciality | General Practice |
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| Experience | 56 Years |
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| Location | 585 Troy Schenectady Rd, Latham, New York |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Everett Roy Forman attended and graduated from Albany Medical College Of Union University in 1968
NPI Data:
- NPI Number: 1528061967
- Provider Enumeration Date: 05/31/2005
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 4486744562
- Enrollment ID: I20071212000701
Medical Identifiers
Medical identifiers for Everett Roy Forman such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1528061967 | NPI | - | NPPES |
| 10000672 | Other | | CDPHP |
| 01148 | Other | | MVP |
| 000401336001 | Other | | BLUE SHIELD OF NENY |
| 49E991 | Other | | EMPIRE BCBS |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208D00000X | General Practice | 103928-1 (New York) | 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. Everett Roy Forman allows following entities to bill medicare on his behalf.
| Entity Name | Everett Forman Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1144402983
PECOS PAC ID: 1557451630
Enrollment ID: O20071212000723 |
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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. Everett Roy Forman 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 |
|---|
Everett Roy Forman, MD
47 Sweet Rd,
Ballston Lake, NY 12019-1805
Ph: (518) 785-6004 | Everett Roy Forman, MD
585 Troy Schenectady Rd,
Latham, NY 12110-2811
Ph: (518) 785-6004 |
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