Jessica Anne Koupal, DNP-FNP, PMHNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Blackhawk, South Dakota. Her current practice location is
8000 Black Hawk Rd Ste 4, Blackhawk, South Dakota. You can reach out to her office (for appointments etc.) via phone at
(605) 431-3388.
Jessica Anne Koupal is licensed to practice in South Dakota (license number CP001656) 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 1306488333.
Provider's Profile
| Full Name | Jessica Anne Koupal |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Psychiatric/mental Health |
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| Location | 8000 Black Hawk Rd Ste 4, Blackhawk, South Dakota |
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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: 1306488333
- Provider Enumeration Date: 10/10/2019
- Last Update Date: 09/07/2023
Medicare PECOS Information:
- PECOS PAC ID: 9234562778
- Enrollment ID: I20191213001625
Medical Identifiers
Medical identifiers for Jessica Anne Koupal such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1306488333 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | CP001656 (South Dakota) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | CP001656 (South Dakota) | 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. Jessica Anne Koupal allows following entities to bill medicare on her behalf.
| Entity Name | Mind Body Connections Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1295519213
PECOS PAC ID: 0941733505
Enrollment ID: O20241104003388 |
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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. Jessica Anne Koupal 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 |
|---|
Jessica Anne Koupal, DNP-FNP, PMHNP
8000 Black Hawk Rd Ste 4,
Black Hawk, SD 57718-3315
Ph: (605) 431-3388 | Jessica Anne Koupal, DNP-FNP, PMHNP
8000 Black Hawk Rd Ste 4,
Blackhawk, SD 57718
Ph: (605) 431-3388 |
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