Mary K Derlacki, FNP is a medicare enrolled "Internal Medicine - Rheumatology" in Boise, Idaho. Her current practice location is
2800 W Overland Rd, Boise, Idaho. You can reach out to her office (for appointments etc.) via phone at
(208) 801-1414.
Mary K Derlacki is licensed to practice in Oregon (license number 090006104N1) 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 1609947431.
Provider's Profile
| Full Name | Mary K Derlacki |
|---|
| Gender | Female |
|---|
| Speciality | Internal Medicine - Rheumatology |
|---|
| Location | 2800 W Overland Rd, Boise, Idaho |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1609947431
- Provider Enumeration Date: 11/13/2006
- Last Update Date: 10/17/2024
Medicare PECOS Information:
- PECOS PAC ID: 4183712052
- Enrollment ID: I20071112000299
Medical Identifiers
Medical identifiers for Mary K Derlacki such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1609947431 | NPI | - | NPPES |
| 005785 | Medicaid | OR | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LF0000X | Nurse Practitioner - Family | 69483 (Idaho) | Secondary |
| 207RR0500X | Internal Medicine - Rheumatology | 090006104N1 (Oregon) | 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 K Derlacki allows following entities to bill medicare on her behalf.
| Entity Name | Drs Cassell & Boren Pc |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1316035728
PECOS PAC ID: 7012904295
Enrollment ID: O20040429000047 |
|---|
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 K Derlacki 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 K Derlacki, FNP
1707 N 19th St,
Boise, ID 83702-0706
Ph: (541) 232-6732 | Mary K Derlacki, FNP
2800 W Overland Rd,
Boise, ID 83705-3038
Ph: (208) 801-1414 |
Reviews and Comments