Jalice Bryan, is a medicare enrolled "Nurse Practitioner - Family" physician in New Haven, Connecticut. Her current practice location is
1351 Whalley Ave, New Haven, Connecticut. You can reach out to her office (for appointments etc.) via phone at
(203) 889-2691.
Jalice Bryan is licensed to practice in Connecticut (license number 11278) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1629788799.
Physician's Profile
| Full Name | Jalice Bryan |
|---|
| Gender | Female |
|---|
| Speciality | Nurse Practitioner - Family |
|---|
| Location | 1351 Whalley Ave, New Haven, Connecticut |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1629788799
- Provider Enumeration Date: 11/30/2022
- Last Update Date: 01/13/2023
Medicare PECOS Information:
- PECOS PAC ID: 2961872783
- Enrollment ID: I20230111002743
Medical Identifiers
Medical identifiers for Jalice Bryan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1629788799 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207R00000X | Internal Medicine | 11278 (Connecticut) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 11278 (Connecticut) | 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. Jalice Bryan allows following entities to bill medicare on her behalf.
| Entity Name | South-west Community Health Center Inc |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1699703686
PECOS PAC ID: 2466445200
Enrollment ID: O20040420001098 |
|---|
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. Jalice Bryan 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 |
|---|
Jalice Bryan,
24 Cambridge St,
Stratford, CT 06614-4711
Ph: (203) 715-1188 | Jalice Bryan,
1351 Whalley Ave,
New Haven, CT 06515-1149
Ph: (203) 889-2691 |
Reviews and Comments