Theresa Malcom, FNP is a medicare enrolled "Nurse Practitioner - Family" physician in Elkhart, Indiana. Her current practice location is
500 Arcade Ave Ste 210, Elkhart, Indiana. You can reach out to her office (for appointments etc.) via phone at
(574) 389-5656.
Theresa Malcom is licensed to practice in Indiana (license number 71012835A) 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 1871224576.
Physician's Profile
| Full Name | Theresa Malcom |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 500 Arcade Ave Ste 210, Elkhart, Indiana |
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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: 1871224576
- Provider Enumeration Date: 06/22/2022
- Last Update Date: 01/11/2023
Medicare PECOS Information:
- PECOS PAC ID: 6406222991
- Enrollment ID: I20221025002513
Medical Identifiers
Medical identifiers for Theresa Malcom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1871224576 | NPI | - | NPPES |
| 300068982 | Medicaid | IN | |
| 236040463 | Other | | MEDICARE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | F05220661 (Indiana) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 71012835A (Indiana) | 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. Theresa Malcom allows following entities to bill medicare on her behalf.
| Entity Name | Beacon Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1033161617
PECOS PAC ID: 1254243306
Enrollment ID: O20031105000657 |
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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. Theresa Malcom 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 |
|---|
Theresa Malcom, FNP
3245 Health Dr Ste 100,
Granger, IN 46530-1380
Ph: (574) 647-2129 | Theresa Malcom, FNP
500 Arcade Ave Ste 210,
Elkhart, IN 46514
Ph: (574) 389-5656 |
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