Dr Marty P Witucki, PHD is a medicare enrolled "Psychologist - Clinical" provider in Gravette, Arkansas. He graduated from medical school in 1993 and has 32 years of diverse experience with area of expertise as Clinical Psychologist. He is a member of the group practice Chenal Family Therapy Plc and his current practice location is
1101 Jackson St Sw, Gravette, Arkansas. You can reach out to his office (for appointments etc.) via phone at
(479) 787-5221.
Dr Marty P Witucki is licensed to practice in Arkansas (license number 16-22P) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1477587772.
Healthcare Provider's Profile
| Full Name | Dr Marty P Witucki |
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| Gender | Male |
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| Speciality | Clinical Psychologist |
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| Experience | 32 Years |
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| Location | 1101 Jackson St Sw, Gravette, Arkansas |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Marty P Witucki graduated from medical school in 1993
NPI Data:
- NPI Number: 1477587772
- Provider Enumeration Date: 07/10/2006
- Last Update Date: 10/16/2023
Medicare PECOS Information:
- PECOS PAC ID: 5799718243
- Enrollment ID: I20180109003432
Medical Identifiers
Medical identifiers for Dr Marty P Witucki such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1477587772 | NPI | - | NPPES |
| 621823700 | Medicaid | MN | |
| 18115 | Medicaid | ND | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC0700X | Psychologist - Clinical | 263 (North Dakota) | Secondary |
| 103TC0700X | Psychologist - Clinical | 16-22P (Arkansas) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Chenal Family Therapy Plc | 8325395627 | 30 |
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 Marty P Witucki allows following entities to bill medicare on his behalf.
| Entity Name | Sgoh Acquisition Inc |
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| Entity Type | Part B Supplier - Hospital Department(s) |
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| Entity Identifiers | NPI Number: 1568643005
PECOS PAC ID: 5092616276
Enrollment ID: O20081016000559 |
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| Entity Name | Chenal Family Therapy Plc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1356604219
PECOS PAC ID: 8325395627
Enrollment ID: O20180718000717 |
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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. Dr Marty P Witucki 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 Marty P Witucki, PHD
1101 Jackson St Sw,
Gravette, AR 72736-9121
Ph: (479) 787-5221 | Dr Marty P Witucki, PHD
1101 Jackson St Sw,
Gravette, AR 72736-9121
Ph: (479) 787-5221 |
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