Ian Mall, is a medicare enrolled "Clinical Nurse Specialist - Home Health" in Ooltewah, Tennessee. His current practice location is
9981 Forrest Dr, Ooltewah, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(423) 362-8192.
Ian Mall is licensed to practice in Tennessee (license number 20836) 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 1144689456.
Provider's Profile
| Full Name | Ian Mall |
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| Gender | Male |
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| Speciality | Clinical Nurse Specialist - Home Health |
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| Location | 9981 Forrest Dr, Ooltewah, Tennessee |
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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: 1144689456
- Provider Enumeration Date: 02/15/2016
- Last Update Date: 02/15/2016
Medicare PECOS Information:
- PECOS PAC ID: 0042548596
- Enrollment ID: I20190822001249
Medical Identifiers
Medical identifiers for Ian Mall such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1144689456 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 364SH0200X | Clinical Nurse Specialist - Home Health | 20836 (Tennessee) | 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. Ian Mall allows following entities to bill medicare on his behalf.
| Entity Name | State Of Tennessee |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1487791315
PECOS PAC ID: 5698687077
Enrollment ID: O20031104000309 |
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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. Ian Mall 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 |
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Ian Mall,
9981 Forrest Dr,
Ooltewah, TN 37363-8300
Ph: (423) 362-8192 | Ian Mall,
9981 Forrest Dr,
Ooltewah, TN 37363-8300
Ph: (423) 362-8192 |
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