Kirsty E Bortnik, PHD is a medicare enrolled "Clinical Neuropsychologist" provider in Santa Monica, California. She graduated from medical school in 2011 and has 14 years of diverse experience with area of expertise as Clinical Psychologist. She is a member of the group practice Providence Saint Johns Medical Foundation and her current practice location is
1301 20th St Ste 150, Santa Monica, California. You can reach out to her office (for appointments etc.) via phone at
(310) 458-2764.
Kirsty E Bortnik is licensed to practice in California (license number 32126) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1376748780.
Healthcare Provider's Profile
| Full Name | Kirsty E Bortnik |
|---|
| Gender | Female |
|---|
| Speciality | Clinical Psychologist |
|---|
| Experience | 14 Years |
|---|
| Location | 1301 20th St Ste 150, Santa Monica, California |
|---|
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
|---|
Medical Education and Training:
- Kirsty E Bortnik graduated from medical school in 2011
NPI Data:
- NPI Number: 1376748780
- Provider Enumeration Date: 06/15/2007
- Last Update Date: 01/09/2024
Medicare PECOS Information:
- PECOS PAC ID: 8820214778
- Enrollment ID: I20210224002697
Medical Identifiers
Medical identifiers for Kirsty E Bortnik such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1376748780 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC0700X | Psychologist - Clinical | 32126 (California) | Secondary |
| 103TC0700X | Psychologist - Clinical | 019916 (New York) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 32126 (California) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Providence Saint Johns Medical Foundation | 0840548624 | 273 |
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. Kirsty E Bortnik allows following entities to bill medicare on her behalf.
| Entity Name | Providence Saint Johns Medical Foundation |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1518438712
PECOS PAC ID: 0840548624
Enrollment ID: O20180810000904 |
|---|
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. Kirsty E Bortnik 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 |
|---|
Kirsty E Bortnik, PHD
Po Box 1493,
Sierra Madre, CA 91025-4493
Ph: (212) 305-3247 | Kirsty E Bortnik, PHD
1301 20th St Ste 150,
Santa Monica, CA 90404-2050
Ph: (310) 458-2764 |
Reviews and Comments