Tim Van Der Perren, is a medicare enrolled "Speech-language Pathologist" provider in Oconto, Wisconsin. His current practice location is
501 Park Ave, Oconto, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(920) 834-6875.
Tim Van Der Perren is licensed to practice in Wisconsin (license number 1928-154) 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 1972615292.
Healthcare Provider's Profile
| Full Name | Tim Van Der Perren |
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| Gender | Male |
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| Speciality | Speech-language Pathologist |
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| Location | 501 Park Ave, Oconto, Wisconsin |
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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: 1972615292
- Provider Enumeration Date: 08/31/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 5799025896
- Enrollment ID: I20190328000547
Medical Identifiers
Medical identifiers for Tim Van Der Perren such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1972615292 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 235Z00000X | Speech-language Pathologist | 1928-154 (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. Tim Van Der Perren allows following entities to bill medicare on his behalf.
| Provider Name | St Clare Memorial Hospital Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1851477913
PECOS PAC ID: 0446211395
Enrollment ID: O20041023000037 |
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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. Tim Van Der Perren 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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Tim Van Der Perren,
2543 Telluride Trl Apt C,
Green Bay, WI 54313-3972
Ph: () - | Tim Van Der Perren,
501 Park Ave,
Oconto, WI 54153-1612
Ph: (920) 834-6875 |
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