Dr Domenick Tirabassi Iv, PSYD in Fond Du Lac, WI - Medicare Psychologist Provider

Dr Domenick Tirabassi Iv, PSYD is a medicare enrolled "Psychologist" provider in Fond Du Lac, Wisconsin. His current practice location is 420 E Division St, Fond Du Lac, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (920) 926-8492.

Dr Domenick Tirabassi Iv is licensed to practice in Wisconsin (license number 5089-57) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1023662459.

Contact Information

	Dr Domenick Tirabassi Iv, PSYD
	420 E Division St, Fond Du Lac, WI 54935-4560
	(920) 926-8492
	(920) 926-8903

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Domenick Tirabassi Iv
Gender	Male
Speciality	Psychologist
Location	420 E Division St, Fond Du Lac, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1023662459
Provider Enumeration Date: 07/24/2019
Last Update Date: 08/31/2024

Medicare PECOS Information:

PECOS PAC ID: 1557716081
Enrollment ID: I20231018001463

Medical Identifiers

Medical identifiers for Dr Domenick Tirabassi Iv such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1023662459	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	5089-57 (Wisconsin)	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. Dr Domenick Tirabassi Iv allows following entities to bill medicare on his behalf.

Entity Name	Agnesian Healthcare Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1346228541 PECOS PAC ID: 1658289624 Enrollment ID: O20031104000263

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. Dr Domenick Tirabassi Iv 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
Dr Domenick Tirabassi Iv, PSYD 420 E Division St, Fond Du Lac, WI 54935-4560 Ph: (920) 926-8492	Dr Domenick Tirabassi Iv, PSYD 420 E Division St, Fond Du Lac, WI 54935-4560 Ph: (920) 926-8492

Reviews and Comments

Psychologist in Fond Du Lac, WI

Dr. Espen Klausen, PH.D. Psychologist Medicare: Accepting Medicare Assignments Practice Location: 459 E 1st St, Fond Du Lac, WI 54935 Phone: 920-929-3529
Nancy L Goranson, PHD Psychologist Medicare: Accepting Medicare Assignments Practice Location: 430 E Division St, Fond Du Lac, WI 54935 Phone: 920-926-4200 Fax: 920-926-8885
Joseph Haney, PSY.D. Psychologist Medicare: Accepting Medicare Assignments Practice Location: 459 E 1st St, Fond Du Lac, WI 54935 Phone: 920-929-3527
Dr. Teri L. Kaczmarek, PSY.D. Psychologist Medicare: Accepting Medicare Assignments Practice Location: 210 Wisconsin American Dr, Fond Du Lac, WI 54937 Phone: 920-907-7000
Clare Lawlor, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 430 E Division St, Fond Du Lac, WI 54935 Phone: 847-331-2227 Fax: 920-926-8933
Troy William Sheide, PSYD Psychologist Medicare: Medicare Enrolled Practice Location: 498 Ruggles St, Fond Du Lac, WI 54935 Phone: 801-703-6192

Dr Domenick Tirabassi Iv, PSYD - Medicare Psychologist in Fond Du Lac, WI