Mr Stephan William Daugherty, NP in Los Angeles, CA

Mr Stephan William Daugherty, NP is a medicare enrolled "Nurse Practitioner - Family" in Los Angeles, California. His current practice location is 10889 Wellworth Ave, Los Angeles, California. You can reach out to his office (for appointments etc.) via phone at (310) 474-2152.

Mr Stephan William Daugherty is licensed to practice in California (license number 95024505) 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 1942902986.

Contact Information

	Mr Stephan William Daugherty, NP
	10889 Wellworth Ave, Los Angeles, CA 90024-4918
	(310) 474-2152
	Not Available

Map and Direction

Provider's Profile

Full Name	Mr Stephan William Daugherty
Gender	Male
Speciality	Nurse Practitioner - Family
Location	10889 Wellworth Ave, Los Angeles, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1942902986
Provider Enumeration Date: 03/21/2023
Last Update Date: 10/27/2024

Medicare PECOS Information:

PECOS PAC ID: 9234595976
Enrollment ID: I20230522003235

Medical Identifiers

Medical identifiers for Mr Stephan William Daugherty such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1942902986	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	95024505 (California)	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. Mr Stephan William Daugherty allows following entities to bill medicare on his behalf.

Entity Name	Minuteclinic Diagnostic Medical Group Of California Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1033309372 PECOS PAC ID: 8224191374 Enrollment ID: O20090115000289

Entity Name	Minuteclinic Diagnostic Medical Group Of Orange County Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1104013879 PECOS PAC ID: 5991868929 Enrollment ID: O20090116000214

Entity Name	Minuteclinic Diagnostic Medical Group Of San Diego Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1568659233 PECOS PAC ID: 2567520414 Enrollment ID: O20090127000249

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 Stephan William Daugherty 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
Mr Stephan William Daugherty, NP 2074 Cerro Gordo St, Los Angeles, CA 90039-3956 Ph: (561) 281-5449	Mr Stephan William Daugherty, NP 10889 Wellworth Ave, Los Angeles, CA 90024-4918 Ph: (310) 474-2152

Reviews and Comments

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Mr Stephan William Daugherty, NP - Medicare Nurse Practitioner in Los Angeles, CA