Kelly Loraine Dauer Pham, MD is a medicare enrolled "Physical Medicine & Rehabilitation - Pediatric Rehabilitation Medicine" physician in Vienna, Virginia. Her current practice location is
8230 Boone Blvd Ste 170, Vienna, Virginia. You can reach out to her office (for appointments etc.) via phone at
(571) 310-2502.
Kelly Loraine Dauer Pham is licensed to practice in Virginia (license number 0101273373) 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 1417274689.
Physician's Profile
| Full Name | Kelly Loraine Dauer Pham |
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| Gender | Female |
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| Speciality | Physical Medicine & Rehabilitation - Pediatric Rehabilitation Medicine |
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| Location | 8230 Boone Blvd Ste 170, Vienna, Virginia |
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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: 1417274689
- Provider Enumeration Date: 04/28/2010
- Last Update Date: 04/13/2022
Medicare PECOS Information:
- PECOS PAC ID: 1759530132
- Enrollment ID: I20160929002777
Medical Identifiers
Medical identifiers for Kelly Loraine Dauer Pham such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1417274689 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208100000X | Physical Medicine & Rehabilitation | 0101273373 (Virginia) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | 185401 (District Of Columbia) | Secondary |
| 2081P0010X | Physical Medicine & Rehabilitation - Pediatric Rehabilitation Medicine | FE60464961 (Washington) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 2081P0010X | Physical Medicine & Rehabilitation - Pediatric Rehabilitation Medicine | 0101273373 (Virginia) | 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. Kelly Loraine Dauer Pham allows following entities to bill medicare on her behalf.
| Entity Name | The Association Of Chrmc And University Physicians |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1255449963
PECOS PAC ID: 9133032964
Enrollment ID: O20031107000585 |
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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. Kelly Loraine Dauer Pham 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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Kelly Loraine Dauer Pham, MD
8230 Boone Blvd Ste 170,
Vienna, VA 22182-2621
Ph: (571) 310-2502 | Kelly Loraine Dauer Pham, MD
8230 Boone Blvd Ste 170,
Vienna, VA 22182-2621
Ph: (571) 310-2502 |
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