Kelly Distefano, in Salt Lake City, UT - Medicare Registered Nurse

Kelly Distefano, is a medicare enrolled "Registered Nurse - Maternal Newborn" in Salt Lake City, Utah. Her current practice location is 50 N Medical Dr, Salt Lake City, Utah. You can reach out to her office (for appointments etc.) via phone at (801) 581-2953.

Kelly Distefano is licensed to practice in Utah (license number 111980483102) 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 1851021018.

Contact Information

	Kelly Distefano,
	50 N Medical Dr, Salt Lake City, UT 84132-0001
	(801) 581-2953
	Not Available

Map and Direction

Provider's Profile

Full Name	Kelly Distefano
Gender	Female
Speciality	Registered Nurse - Maternal Newborn
Location	50 N Medical Dr, Salt Lake City, Utah
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1851021018
Provider Enumeration Date: 06/12/2022
Last Update Date: 06/12/2022

Medicare PECOS Information:

PECOS PAC ID: 9032555164
Enrollment ID: I20240312002540

Medical Identifiers

Medical identifiers for Kelly Distefano such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1851021018	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163WM0102X	Registered Nurse - Maternal Newborn	111980483102 (Utah)	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. Kelly Distefano allows following entities to bill medicare on her behalf.

Entity Name	Ihc Health Services Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1942325154 PECOS PAC ID: 1850209420 Enrollment ID: O20080610000303

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. Kelly Distefano 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
Kelly Distefano, 2165 S 1700 E, Salt Lake City, UT 84106-4122 Ph: (860) 462-8204	Kelly Distefano, 50 N Medical Dr, Salt Lake City, UT 84132-0001 Ph: (801) 581-2953

Reviews and Comments

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Kelly Distefano, - Medicare Registered Nurse in Salt Lake City, UT