Ross Hazlewood, DO is a medicare enrolled "Family Medicine" physician in Markesan, Wisconsin. His current practice location is
340 Enterprise Drive, Markesan, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(920) 398-2321.
Ross Hazlewood is licensed to practice in Wisconsin (license number 30950-021) 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 1316948847.
Physician's Profile
| Full Name | Ross Hazlewood |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 340 Enterprise Drive, Markesan, Wisconsin |
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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: 1316948847
- Provider Enumeration Date: 08/09/2005
- Last Update Date: 10/24/2014
Medicare PECOS Information:
- PECOS PAC ID: 6002940442
- Enrollment ID: I20100819001260
Medical Identifiers
Medical identifiers for Ross Hazlewood such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1316948847 | NPI | - | NPPES |
| 30047100 | Medicaid | WI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 30950-021 (Wisconsin) | Primary |
| 208600000X | Surgery | 30950-021 (Wisconsin) | 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. Ross Hazlewood allows following entities to bill medicare on his behalf.
| Entity Name | Thedacare, Incorporated |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1376656959
PECOS PAC ID: 1759294887
Enrollment ID: O20031106000088 |
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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. Ross Hazlewood 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 |
|---|
Ross Hazlewood, DO
340 Enterprise Drive,
Markesan, WI 53946
Ph: (920) 398-2321 | Ross Hazlewood, DO
340 Enterprise Drive,
Markesan, WI 53946
Ph: (920) 398-2321 |
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