Tracy-jane Luyun Fajota, AGACNP-BC in Glendale, CA

Tracy-jane Luyun Fajota, AGACNP-BC is a medicare enrolled "Nurse Practitioner - Acute Care" in Glendale, California. Her current practice location is 1420 S Central Ave, Glendale, California. You can reach out to her office (for appointments etc.) via phone at (818) 502-1900.

Tracy-jane Luyun Fajota is licensed to practice in California (license number 95025937) 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 1700660560.

Contact Information

	Tracy-jane Luyun Fajota, AGACNP-BC
	1420 S Central Ave, Glendale, CA 91204-2508
	(818) 502-1900
	Not Available

Map and Direction

Provider's Profile

Full Name	Tracy-jane Luyun Fajota
Gender	Female
Speciality	Nurse Practitioner - Acute Care
Location	1420 S Central Ave, Glendale, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1700660560
Provider Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023

Medicare PECOS Information:

PECOS PAC ID: 3173978194
Enrollment ID: I20231011003343

Medical Identifiers

Medical identifiers for Tracy-jane Luyun Fajota such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1700660560	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LA2100X	Nurse Practitioner - Acute Care	95025937 (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. Tracy-jane Luyun Fajota allows following entities to bill medicare on her behalf.

Entity Name	Lakeside Medical Organization A Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1831426642 PECOS PAC ID: 7618005166 Enrollment ID: O20100505000015

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. Tracy-jane Luyun Fajota 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
Tracy-jane Luyun Fajota, AGACNP-BC 8510 Balboa Blvd Ste 150, Northridge, CA 91325-5810 Ph: (818) 636-0501	Tracy-jane Luyun Fajota, AGACNP-BC 1420 S Central Ave, Glendale, CA 91204-2508 Ph: (818) 502-1900

Reviews and Comments

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Tracy-jane Luyun Fajota, AGACNP-BC - Medicare Nurse Practitioner in Glendale, CA