Amanda Black, MOT, OTR/L is a medicare enrolled "Occupational Therapist" provider in Potlatch, Idaho. Her current practice location is
510 Elm St, Potlatch, Idaho. You can reach out to her office (for appointments etc.) via phone at
(208) 669-3186.
Amanda Black is licensed to practice in Idaho (license number OT-1112) 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 1992362818.
Healthcare Provider's Profile
| Full Name | Amanda Black |
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| Gender | Female |
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| Speciality | Occupational Therapist |
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| Location | 510 Elm St, Potlatch, Idaho |
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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: 1992362818
- Provider Enumeration Date: 05/27/2019
- Last Update Date: 04/08/2022
Medicare PECOS Information:
- PECOS PAC ID: 4789910852
- Enrollment ID: I20190726001502
Medical Identifiers
Medical identifiers for Amanda Black such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1992362818 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225XP0200X | Occupational Therapist - Pediatrics | OT-1112 (Idaho) | Secondary |
| 225X00000X | Occupational Therapist | OT-1112 (Idaho) | 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. Amanda Black allows following entities to bill medicare on her behalf.
| Provider Name | Bk Inc. |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1659429405
PECOS PAC ID: 6406948090
Enrollment ID: O20070828000276 |
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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. Amanda Black 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 |
|---|
Amanda Black, MOT, OTR/L
1026 Grange Park Rd,
Princeton, ID 83857-5500
Ph: (208) 669-3186 | Amanda Black, MOT, OTR/L
510 Elm St,
Potlatch, ID 83855
Ph: (208) 669-3186 |
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