Tasha Lee Godbolt, is a medicare enrolled "Family Medicine - Adult Medicine" physician in Roselle Park, New Jersey. Her current practice location is
141 Chestnut St Ste 201, Roselle Park, New Jersey. You can reach out to her office (for appointments etc.) via phone at
(973) 223-2933.
Tasha Lee Godbolt is licensed to practice in New Jersey (license number 0) 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 1457034951.
Physician's Profile
Full Name | Tasha Lee Godbolt |
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Gender | Female |
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Speciality | Family Medicine - Adult Medicine |
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Location | 141 Chestnut St Ste 201, Roselle Park, New Jersey |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1457034951
- Provider Enumeration Date: 08/10/2023
- Last Update Date: 02/26/2024
Medicare PECOS Information:
- PECOS PAC ID: 8628421229
- Enrollment ID: I20240131000896
Medical Identifiers
Medical identifiers for Tasha Lee Godbolt such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1457034951 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207QA0505X | Family Medicine - Adult Medicine | 0 (New Jersey) | 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. Tasha Lee Godbolt allows following entities to bill medicare on her behalf.
Entity Name | Nurse Practitioner Professional Resources |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1558516260 PECOS PAC ID: 1951450931 Enrollment ID: O20090521000466 |
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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. Tasha Lee Godbolt 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 |
Tasha Lee Godbolt, 141 Chestnut St Ste 201, Roselle Park, NJ 07204-2282 Ph: (973) 223-2933 | Tasha Lee Godbolt, 141 Chestnut St Ste 201, Roselle Park, NJ 07204-2282 Ph: (973) 223-2933 |
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