Mary Boontung, in Gilbert, AZ - Medicare Nurse Practitioner

Mary Boontung, is a medicare enrolled "Nurse Practitioner - Family" in Gilbert, Arizona. Her current practice location is 3458 E Casa Mader Dr, Gilbert, Arizona. You can reach out to her office (for appointments etc.) via phone at (310) 989-9710.

Mary Boontung is licensed to practice in Arizona (license number 220096) 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 1790567816.

Contact Information

	Mary Boontung,
	3458 E Casa Mader Dr, Gilbert, AZ 85298-4202
	(310) 989-9710
	Not Available

Map and Direction

Provider's Profile

Full Name	Mary Boontung
Gender	Female
Speciality	Nurse Practitioner - Family
Location	3458 E Casa Mader Dr, Gilbert, Arizona
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1790567816
Provider Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023

Medicare PECOS Information:

PECOS PAC ID: 5890139752
Enrollment ID: I20240219002487

Medical Identifiers

Medical identifiers for Mary Boontung such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1790567816	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	220096 (Arizona)	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. Mary Boontung allows following entities to bill medicare on her behalf.

Entity Name	Allied Internal Medicine Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1124408232 PECOS PAC ID: 7315251964 Enrollment ID: O20150917003141

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. Mary Boontung 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
Mary Boontung, 3458 E Casa Mader Dr, Gilbert, AZ 85298-4202 Ph: (310) 989-9710	Mary Boontung, 3458 E Casa Mader Dr, Gilbert, AZ 85298-4202 Ph: (310) 989-9710

Reviews and Comments

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Mary Boontung, - Medicare Nurse Practitioner in Gilbert, AZ