Tisha Marie Larsen, in Roseburg, OR - Medicare Registered Nurse

Tisha Marie Larsen, is a medicare enrolled "Registered Nurse - Psychiatric/mental Health, Adult" in Roseburg, Oregon. Her current practice location is 621 W Madrone St, Roseburg, Oregon. You can reach out to her office (for appointments etc.) via phone at (541) 440-3500.

Tisha Marie Larsen is licensed to practice in Oregon (license number 201910861NP-PP) 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 1578954855.

Contact Information

	Tisha Marie Larsen,
	621 W Madrone St, Roseburg, OR 97470-3090
	(541) 440-3500
	(541) 957-3003

Map and Direction

Provider's Profile

Full Name	Tisha Marie Larsen
Gender	Female
Speciality	Registered Nurse - Psychiatric/mental Health, Adult
Location	621 W Madrone St, Roseburg, Oregon
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1578954855
Provider Enumeration Date: 02/09/2015
Last Update Date: 10/12/2021

Medicare PECOS Information:

PECOS PAC ID: 2668791351
Enrollment ID: I20181105000870

Medical Identifiers

Medical identifiers for Tisha Marie Larsen such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1578954855	NPI	-	NPPES
165772	Medicaid	OR

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	201500780NP-PP (Oregon)	Secondary
163WP0809X	Registered Nurse - Psychiatric/mental Health, Adult	201910861NP-PP (Oregon)	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. Tisha Marie Larsen allows following entities to bill medicare on her behalf.

Entity Name	Adapt
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1720010549 PECOS PAC ID: 4587662887 Enrollment ID: O20061121000327

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. Tisha Marie Larsen 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
Tisha Marie Larsen, Po Box 1121, Roseburg, OR 97470-0254 Ph: (541) 672-2691	Tisha Marie Larsen, 621 W Madrone St, Roseburg, OR 97470-3090 Ph: (541) 440-3500

Reviews and Comments

Registered Nurse Nurses in Roseburg, OR

Catherine Joyce Paul, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 621 W Madrone St, Roseburg, OR 97470 Phone: 541-440-3571 Fax: 541-957-3704
Mr. Fredrick Ryan Wilkins, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 913 Garden Valley Blvd, Roseburg, OR 97471 Phone: 541-440-1000 Fax: 541-677-3189
Gerilynn Jutson, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471 Phone: 541-677-7200 Fax: 541-229-3309
Erin P Cassidy, FNP Registered Nurse Medicare: Accepting Medicare Assignments Practice Location: 780 Nw Garden Valley Blvd Ste 310, Roseburg, OR 97471 Phone: 541-640-7625
Melissa Heselius, RN Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 913 Nw Garden Valley Blvd, Roseburg, OR 97471 Phone: 541-440-1000
Shelli Cross, Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 2700 Nw Stewart Pkwy, Roseburg, OR 97471 Phone: 541-677-4845
Brittney Gardner, Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 548 Se Jackson St, Roseburg, OR 97470 Phone: 541-440-3532

Tisha Marie Larsen, - Medicare Registered Nurse in Roseburg, OR