Dr Mira B Shore, PSYD is a medicare enrolled "Counselor" provider in Philadelphia, Pennsylvania. Her current practice location is
850 N 11th St, Philadelphia, Pennsylvania. You can reach out to her office (for appointments etc.) via phone at
(267) 597-3604.
Dr Mira B Shore is licensed to practice in * (Not Available) (license number ) 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 1750079067.
Healthcare Provider's Profile
| Full Name | Dr Mira B Shore |
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| Gender | Female |
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| Speciality | Counselor |
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| Location | 850 N 11th St, Philadelphia, Pennsylvania |
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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: 1750079067
- Provider Enumeration Date: 04/25/2023
- Last Update Date: 10/07/2024
Medicare PECOS Information:
- PECOS PAC ID: 3274064019
- Enrollment ID: I20241003001289
Medical Identifiers
Medical identifiers for Dr Mira B Shore such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1750079067 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 101Y00000X | Counselor | (* (Not Available)) | 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 Mira B Shore allows following entities to bill medicare on her behalf.
| Entity Name | Moore Psychological Services Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1164769543
PECOS PAC ID: 0648415646
Enrollment ID: O20130322000023 |
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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 Mira B Shore 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 Mira B Shore, PSYD
921 Chester Pike,
Sharon Hill, PA 19079-1411
Ph: (610) 639-0795 | Dr Mira B Shore, PSYD
850 N 11th St,
Philadelphia, PA 19123-1957
Ph: (267) 597-3604 |
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