Mr Iwan Sutana, MBA, MSN, AGACNP-BC in Palo Alto, CA

Mr Iwan Sutana, MBA, MSN, AGACNP-BC is a medicare enrolled "Nurse Practitioner - Acute Care" in Palo Alto, California. His current practice location is 300 Pasteur Dr, Palo Alto, California. You can reach out to his office (for appointments etc.) via phone at (650) 723-2091.

Mr Iwan Sutana is licensed to practice in California (license number 95007809) 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 1194250670.

Contact Information

	Mr Iwan Sutana, MBA, MSN, AGACNP-BC
	300 Pasteur Dr, Palo Alto, CA 94305-2200
	(650) 723-2091
	Not Available

Map and Direction

Provider's Profile

Full Name	Mr Iwan Sutana
Gender	Male
Speciality	Nurse Practitioner - Acute Care
Location	300 Pasteur Dr, Palo Alto, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1194250670
Provider Enumeration Date: 04/21/2017
Last Update Date: 12/28/2021

Medicare PECOS Information:

PECOS PAC ID: 3173880069
Enrollment ID: I20171130003352

Medical Identifiers

Medical identifiers for Mr Iwan Sutana such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1194250670	NPI	-	NPPES
695922	Other	CA	CA BRN
71519	Other	CA	CALIFORNIA BOARD OF REGISTERED NURSING
95007809	Other	CA	CALIFORNIA BOARD OF REGISTERED NURSING

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163WC0200X	Registered Nurse - Critical Care Medicine	695922 (California)	Secondary
163WC1500X	Registered Nurse - Community Health	71519 (California)	Secondary
363L00000X	Nurse Practitioner	95007809 (California)	Secondary
363LA2200X	Nurse Practitioner - Adult Health	95007809 (California)	Secondary
363LG0600X	Nurse Practitioner - Gerontology	95007809 (California)	Secondary
363LA2100X	Nurse Practitioner - Acute Care	95007809 (California)	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. Mr Iwan Sutana allows following entities to bill medicare on his behalf.

Entity Name	Permanente Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710

Entity Name	Stanford Health Care
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1437292927 PECOS PAC ID: 6709797491 Enrollment ID: O20031124000348

Entity Name	Lpch Medical Group Div Of Lucile
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1417907940 PECOS PAC ID: 0840298543 Enrollment ID: O20061113000232

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. Mr Iwan Sutana 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
Mr Iwan Sutana, MBA, MSN, AGACNP-BC 300 Pasteur Dr, Stanford, CA 94305-2200 Ph: (650) 723-4000	Mr Iwan Sutana, MBA, MSN, AGACNP-BC 300 Pasteur Dr, Palo Alto, CA 94305-2200 Ph: (650) 723-2091

Reviews and Comments

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Mr Iwan Sutana, MBA, MSN, AGACNP-BC - Medicare Nurse Practitioner in Palo Alto, CA