Mrs Ivana P Fukumoto, APN in Las Vegas, NV - Medicare Nurse Practitioner

Mrs Ivana P Fukumoto, APN is a medicare enrolled "Nurse Practitioner - Family" in Las Vegas, Nevada. Her current practice location is 5575 S Durango Dr Ste 103, Las Vegas, Nevada. You can reach out to her office (for appointments etc.) via phone at (702) 435-5437.

Mrs Ivana P Fukumoto is licensed to practice in Nevada (license number APN001217) 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 1114234630.

Contact Information

	Mrs Ivana P Fukumoto, APN
	5575 S Durango Dr Ste 103, Las Vegas, NV 89113-1834
	(702) 435-5437
	(702) 851-9640

Map and Direction

Provider's Profile

Full Name	Mrs Ivana P Fukumoto
Gender	Female
Speciality	Nurse Practitioner - Family
Location	5575 S Durango Dr Ste 103, Las Vegas, Nevada
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1114234630
Provider Enumeration Date: 09/03/2010
Last Update Date: 11/03/2022

Medicare PECOS Information:

PECOS PAC ID: 8022264381
Enrollment ID: I20120802000290

Medical Identifiers

Medical identifiers for Mrs Ivana P Fukumoto such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1114234630	NPI	-	NPPES
1114234630	Medicaid	NV

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	APN001217 (Nevada)	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. Mrs Ivana P Fukumoto allows following entities to bill medicare on her behalf.

Entity Name	Intermountain Medical Holdings Nevada Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1245997279 PECOS PAC ID: 7416054622 Enrollment ID: O20220214001765

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. Mrs Ivana P Fukumoto 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
Mrs Ivana P Fukumoto, APN 6355 S Buffalo Dr Fl 3, Las Vegas, NV 89113-2133 Ph: (702) 216-3346	Mrs Ivana P Fukumoto, APN 5575 S Durango Dr Ste 103, Las Vegas, NV 89113-1834 Ph: (702) 435-5437

Reviews and Comments

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Mrs Ivana P Fukumoto, APN - Medicare Nurse Practitioner in Las Vegas, NV