Ethlene Evette Dade, FNP in Victorville, CA - Medicare Nurse Practitioner

Ethlene Evette Dade, FNP is a medicare enrolled "Nurse Practitioner - Family" in Victorville, California. Her current practice location is 14390 Dalton Ct, Victorville, California. You can reach out to her office (for appointments etc.) via phone at (323) 973-3647.

Ethlene Evette Dade is licensed to practice in California (license number 95025043) 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 1417649013.

Contact Information

	Ethlene Evette Dade, FNP
	14390 Dalton Ct, Victorville, CA 92394-3212
	(323) 973-3647
	Not Available

Map and Direction

Provider's Profile

Full Name	Ethlene Evette Dade
Gender	Female
Speciality	Nurse Practitioner - Family
Location	14390 Dalton Ct, Victorville, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1417649013
Provider Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023

Medicare PECOS Information:

PECOS PAC ID: 9133582646
Enrollment ID: I20230831001545

Medical Identifiers

Medical identifiers for Ethlene Evette Dade such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1417649013	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	95025043 (California)	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. Ethlene Evette Dade allows following entities to bill medicare on her behalf.

Entity Name	Providence Medical Foundation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1285890624 PECOS PAC ID: 8921993205 Enrollment ID: O20040216001346

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. Ethlene Evette Dade 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
Ethlene Evette Dade, FNP 14390 Dalton Ct, Victorville, CA 92394-3212 Ph: (323) 973-3647	Ethlene Evette Dade, FNP 14390 Dalton Ct, Victorville, CA 92394-3212 Ph: (323) 973-3647

Reviews and Comments

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Ethlene Evette Dade, FNP - Medicare Nurse Practitioner in Victorville, CA