Mallory Ellen Imberg, SLP is a medicare enrolled "Speech-language Pathologist" provider in Aurora, Minnesota. Her current practice location is
5211 Highway 110, Aurora, Minnesota. You can reach out to her office (for appointments etc.) via phone at
(218) 229-3311.
Mallory Ellen Imberg is licensed to practice in Minnesota (license number 9978) 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 1174024095.
Healthcare Provider's Profile
| Full Name | Mallory Ellen Imberg |
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| Gender | Female |
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| Speciality | Speech-language Pathologist |
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| Location | 5211 Highway 110, Aurora, Minnesota |
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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: 1174024095
- Provider Enumeration Date: 02/26/2018
- Last Update Date: 02/26/2018
Medicare PECOS Information:
- PECOS PAC ID: 6709120454
- Enrollment ID: I20181206000883
Medical Identifiers
Medical identifiers for Mallory Ellen Imberg such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1174024095 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 235Z00000X | Speech-language Pathologist | 9978 (Minnesota) | 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. Mallory Ellen Imberg allows following entities to bill medicare on her behalf.
| Provider Name | St Lukes Hospital Of Duluth |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1902845068
PECOS PAC ID: 7113834839
Enrollment ID: O20031120000212 |
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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. Mallory Ellen Imberg 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 |
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Mallory Ellen Imberg, SLP
1702 University Dr S,
Fargo, ND 58103-4940
Ph: (701) 364-4222 | Mallory Ellen Imberg, SLP
5211 Highway 110,
Aurora, MN 55705-1522
Ph: (218) 229-3311 |
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