Ni Ketut Supiyati, in Huntington Park, CA - Medicare Nurse Practitioner

Ni Ketut Supiyati, is a medicare enrolled "Nurse Practitioner" in Huntington Park, California. Her current practice location is 2638 E Florence Ave, Huntington Park, California. You can reach out to her office (for appointments etc.) via phone at (323) 581-4665.

Ni Ketut Supiyati is licensed to practice in California (license number NP95001498) 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 1023497443.

Contact Information

	Ni Ketut Supiyati,
	2638 E Florence Ave, Huntington Park, CA 90255-4708
	(323) 581-4665
	(323) 581-0551

Map and Direction

Provider's Profile

Full Name	Ni Ketut Supiyati
Gender	Female
Speciality	Nurse Practitioner
Location	2638 E Florence Ave, Huntington Park, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1023497443
Provider Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015

Medicare PECOS Information:

PECOS PAC ID: 8628365749
Enrollment ID: I20180815003673

Medical Identifiers

Medical identifiers for Ni Ketut Supiyati such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1023497443	NPI	-	NPPES
95001498	Medicaid	CA

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363L00000X	Nurse Practitioner	NP95001498 (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. Ni Ketut Supiyati allows following entities to bill medicare on her behalf.

Entity Name	Complete Women Care, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1376569830 PECOS PAC ID: 5092742320 Enrollment ID: O20050719000618

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. Ni Ketut Supiyati 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
Ni Ketut Supiyati, 2638 E Florence Ave, Huntington Park, CA 90255-4708 Ph: (323) 581-4665	Ni Ketut Supiyati, 2638 E Florence Ave, Huntington Park, CA 90255-4708 Ph: (323) 581-4665

Reviews and Comments

Nurse Practitioner Nurses in Huntington Park, CA

Deborah Kim, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2750 E Slauson Ave, Huntington Park, CA 90255 Phone: 323-583-3010 Fax: 323-581-2035
Julie Farida Ayouby, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 7300 Santa Fe Ave, Huntington Park, CA 90255 Phone: 323-277-8902
Meshi Amzalag, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 7301 State St, Huntington Park, CA 90255 Phone: 323-581-5120
Stephanie Ngsee, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1900 E Slauson Ave, Huntington Park, CA 90255 Phone: 323-487-4110
Mrs. Samantha Aispuro, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 6601 Rugby Ave Ste 300, Huntington Park, CA 90255 Phone: 323-582-1177
Elvia Mexicano, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 6601 Rugby Ave Ste 300, Huntington Park, CA 90255 Phone: 323-582-1177

Ni Ketut Supiyati, - Medicare Nurse Practitioner in Huntington Park, CA