Jason Qualley, MD, CCP,LP is a medicare enrolled "Pain Medicine - Interventional Pain Medicine" physician in Crestview, Florida. His current practice location is
182 E Redstone Ave Ste A, Crestview, Florida. You can reach out to his office (for appointments etc.) via phone at
(855) 527-7246.
Jason Qualley is licensed to practice in Florida (license number ME165604) 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 1215432901.
Physician's Profile
| Full Name | Jason Qualley |
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| Gender | Male |
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| Speciality | Pain Medicine - Interventional Pain Medicine |
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| Location | 182 E Redstone Ave Ste A, Crestview, Florida |
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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: 1215432901
- Provider Enumeration Date: 03/26/2018
- Last Update Date: 11/07/2024
Medicare PECOS Information:
- PECOS PAC ID: 0749611481
- Enrollment ID: I20240304000014
Medical Identifiers
Medical identifiers for Jason Qualley such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1215432901 | NPI | - | NPPES |
| 121439800 | Medicaid | FL | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207R00000X | Internal Medicine | 613883 (Texas) | Secondary |
| 208M00000X | Hospitalist | ME165604 (Florida) | Secondary |
| 242T00000X | Perfusionist | (* (Not Available)) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | ME165604 (Florida) | 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. Jason Qualley allows following entities to bill medicare on his behalf.
| Entity Name | Lee Memorial Health System |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1992873319
PECOS PAC ID: 8729996608
Enrollment ID: O20031118000604 |
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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. Jason Qualley 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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Jason Qualley, MD, CCP,LP
201 Defense Hwy Ste 205,
Annapolis, MD 21401-7096
Ph: (855) 527-7246 | Jason Qualley, MD, CCP,LP
182 E Redstone Ave Ste A,
Crestview, FL 32539-5371
Ph: (855) 527-7246 |
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