Paul V Detrisac, MD in Niles, MI - Medicare Internal Medicine

Paul V Detrisac, MD is a medicare enrolled "Internal Medicine - Critical Care Medicine" physician in Niles, Michigan. His current practice location is 24 N St Joseph Ave, Niles, Michigan. You can reach out to his office (for appointments etc.) via phone at (269) 684-8356.

Paul V Detrisac is licensed to practice in Michigan (license number PD043661) 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 1962506527.

Contact Information

	Paul V Detrisac, MD
	24 N St Joseph Ave, Niles, MI 49120
	(269) 684-8356
	Not Available

Map and Direction

Physician's Profile

Full Name	Paul V Detrisac
Gender	Male
Speciality	Internal Medicine - Critical Care Medicine
Location	24 N St Joseph Ave, Niles, Michigan
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1962506527
Provider Enumeration Date: 09/12/2006
Last Update Date: 07/10/2007

Medicare PECOS Information:

PECOS PAC ID: 8921070038
Enrollment ID: I20040810000308

Medical Identifiers

Medical identifiers for Paul V Detrisac such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1962506527	NPI	-	NPPES
1508904	Medicaid	MI

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207RC0200X	Internal Medicine - Critical Care Medicine	PD043661 (Michigan)	Primary
207RC0200X	Internal Medicine - Critical Care Medicine	01032411A (Indiana)	Secondary

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. Paul V Detrisac allows following entities to bill medicare on his behalf.

Entity Name	Lakeland Medical Practices
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1538397120 PECOS PAC ID: 1658427042 Enrollment ID: O20090928000216

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. Paul V Detrisac 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
Paul V Detrisac, MD Po Box 998, Niles, MI 49120 Ph: (269) 684-8356	Paul V Detrisac, MD 24 N St Joseph Ave, Niles, MI 49120 Ph: (269) 684-8356

Reviews and Comments

Internal Medicine Doctors in Niles, MI

Dr. Dennis L Disch, M.D. Critical Care Medicine Medicare: Accepting Medicare Assignments Practice Location: 61 N Saint Joseph Ave, Niles, MI 49120 Phone: 269-684-6777 Fax: 269-683-5384
Mrs. Ashley Marie Fugate, FNP-BC Critical Care Medicine Medicare: Accepting Medicare Assignments Practice Location: 2002 S 11th St, Niles, MI 49120 Phone: 269-687-0200
Mr. Jamie Hugh Stone, M.D. Critical Care Medicine Medicare: Medicare Enrolled Practice Location: 1915 High Mdw N, Niles, MI 49120 Phone: 574-387-7616
Dr. Jason C Tompkins, MD Critical Care Medicine Medicare: Accepting Medicare Assignments Practice Location: 31 N Saint Joseph Ave, Niles, MI 49120 Phone: 269-687-5510 Fax: 269-684-0189
Barbara J Boyd, MD Critical Care Medicine Medicare: Medicare Enrolled Practice Location: 122 Grant St, Niles, MI 49120 Phone: 269-687-1136 Fax: 269-684-0189
Dr. Richard L Bardin, MD Critical Care Medicine Medicare: Not Enrolled in Medicare Practice Location: 2002 S 11th St, Niles, MI 49120 Phone: 269-687-0200 Fax: 269-684-0199
John-phillip Thomas Markovic, MD Critical Care Medicine Medicare: Medicare Enrolled Practice Location: 31 N Saint Joseph Ave, Niles, MI 49120 Phone: 269-684-6777

Paul V Detrisac, MD - Medicare Internal Medicine in Niles, MI