Stacy M Pemberton, is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Sequatchie, Tennessee. Her current practice location is
298 Sequatchie Mountain Rd, Sequatchie, Tennessee. You can reach out to her office (for appointments etc.) via phone at
(423) 605-7415.
Stacy M Pemberton is licensed to practice in Tennessee (license number 36877) 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 1063241438.
Provider's Profile
| Full Name | Stacy M Pemberton |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Psychiatric/mental Health |
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| Location | 298 Sequatchie Mountain Rd, Sequatchie, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1063241438
- Provider Enumeration Date: 08/01/2024
- Last Update Date: 08/01/2024
Medicare PECOS Information:
- PECOS PAC ID: 6406381813
- Enrollment ID: I20241121004536
Medical Identifiers
Medical identifiers for Stacy M Pemberton such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1063241438 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 36877 (Tennessee) | 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. Stacy M Pemberton allows following entities to bill medicare on her behalf.
| Entity Name | Knoxville Center For Behavioral Medicine Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1710640776
PECOS PAC ID: 0244624195
Enrollment ID: O20230608000113 |
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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. Stacy M Pemberton 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 |
|---|
Stacy M Pemberton,
298 Sequatchie Mountain Rd,
Sequatchie, TN 37374-5000
Ph: (423) 605-7415 | Stacy M Pemberton,
298 Sequatchie Mountain Rd,
Sequatchie, TN 37374-5000
Ph: (423) 605-7415 |
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