Raven Custalow, AGPCNP-BC in Aylett, VA - Medicare Nurse Practitioner

Raven Custalow, AGPCNP-BC is a medicare enrolled "Nurse Practitioner - Primary Care" in Aylett, Virginia. Her current practice location is 7864 Richmond Tappahannock Hwy, Aylett, Virginia. You can reach out to her office (for appointments etc.) via phone at (804) 769-2015.

Raven Custalow is licensed to practice in Virginia (license number 0024176579) 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 1669955019.

Contact Information

	Raven Custalow, AGPCNP-BC
	7864 Richmond Tappahannock Hwy, Aylett, VA 23009-3056
	(804) 769-2015
	Not Available

Map and Direction

Provider's Profile

Full Name	Raven Custalow
Gender	Female
Speciality	Nurse Practitioner - Primary Care
Location	7864 Richmond Tappahannock Hwy, Aylett, Virginia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1669955019
Provider Enumeration Date: 09/12/2018
Last Update Date: 11/08/2024

Medicare PECOS Information:

PECOS PAC ID: 0840543013
Enrollment ID: I20181106000339

Medical Identifiers

Medical identifiers for Raven Custalow such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1669955019	NPI	-	NPPES
3001529971	Medicaid	VA

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP2300X	Nurse Practitioner - Primary Care	0024176579 (Virginia)	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. Raven Custalow allows following entities to bill medicare on her behalf.

Entity Name	Riverside Physician Services Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1194929026 PECOS PAC ID: 5092608448 Enrollment ID: O20040207000400

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. Raven Custalow 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
Raven Custalow, AGPCNP-BC 3944 Upshaw Rd, Aylett, VA 23009-2912 Ph: (804) 928-8477	Raven Custalow, AGPCNP-BC 7864 Richmond Tappahannock Hwy, Aylett, VA 23009-3056 Ph: (804) 769-2015

Reviews and Comments

Nurse Practitioner Nurses in Aylett, VA

Latricia Broaddus, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 5833 Richmond Tappahannock Hwy Ste 106b, Aylett, VA 23009 Phone: 042-230-0298
Mrs. Molly Baldwin Massey, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4917 Richmond Tappahannock Hwy Ste 1b, Aylett, VA 23009 Phone: 804-769-1245 Fax: 804-769-1342
Sara Eleanor Hooper Majewski, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 4917 Richmond Tappahannock Hwy Ste 1b, King William Medical Center, Aylett, VA 23009 Phone: 804-769-1245 Fax: 804-769-1342
Phyllis R. Sykes, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 11814 King William Rd, Aylett, VA 23009 Phone: 804-769-3022 Fax: 804-769-1253
Andrea Garrett, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4917 Richmond Tappahannock Hwy Ste 1b, Aylett, VA 23009 Phone: 804-769-1245
Britten White, N.P. Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 359 Laurel Dr, Aylett, VA 23009 Phone: 804-885-0565
Angel Daniels, DNP, FNP-BC, RN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4917 Richmond Tappahannock Hwy Ste 18, Aylett, VA 23009 Phone: 804-769-1245

Raven Custalow, AGPCNP-BC - Medicare Nurse Practitioner in Aylett, VA