Mr Ephraim Tata Fombo, PMHNP-BC - Medicare Nurse Practitioner in San Antonio, TX

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Mr Ephraim Tata Fombo, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in San Antonio, Texas. His current practice location is 3031 W Ih 10, Attn: Credentialing Dept, San Antonio, Texas. You can reach out to his office (for appointments etc.) via phone at (210) 261-1000.

Mr Ephraim Tata Fombo is licensed to practice in Texas (license number RN796897) 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 1134368327.

Contact Information

Mr Ephraim Tata Fombo, PMHNP-BC
3031 W Ih 10, Attn: Credentialing Dept,
San Antonio, TX 78201-5159
(210) 261-1000
(210) 731-8678

Map and Direction




Provider's Profile

Full NameMr Ephraim Tata Fombo
GenderMale
SpecialityNurse Practitioner - Psychiatric/mental Health
Location3031 W Ih 10, San Antonio, Texas
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1134368327
  • Provider Enumeration Date: 02/11/2009
  • Last Update Date: 11/08/2016
  Medicare PECOS Information:
  • PECOS PAC ID: 2062793581
  • Enrollment ID: I20161221000980

Medical Identifiers

Medical identifiers for Mr Ephraim Tata Fombo such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1134368327NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
163W00000XRegistered Nurse RN 330129 (Ohio)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health RN796897 (Texas)Primary
163W00000XRegistered Nurse 796897 (Texas)Secondary

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. Mr Ephraim Tata Fombo allows following entities to bill medicare on his behalf.
Entity NameMypsych Mental Health, Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1871962191
PECOS PAC ID: 5890078042
Enrollment ID: O20170213002322
Entity NameRoyaltystar Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1306414313
PECOS PAC ID: 1850797978
Enrollment ID: O20210914003770
Entity NameGrow Healthcare Group Pa
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1245845932
PECOS PAC ID: 3476961368
Enrollment ID: O20220525002138

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. Mr Ephraim Tata Fombo 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 AddressPractice Location Address
Mr Ephraim Tata Fombo, PMHNP-BC
3031 W Ih 10,
San Antonio, TX 78201-5159

Ph: (210) 261-1000		Mr Ephraim Tata Fombo, PMHNP-BC
3031 W Ih 10, Attn: Credentialing Dept,
San Antonio, TX 78201-5159

Ph: (210) 261-1000

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

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