Restore Vascular Pllc is a medicare enrolled "Phlebology" provider in Queen Creek, Arizona. Their current practice location is
18510 E San Tan Blvd Ste 115, Queen Creek, Arizona. You can reach out to their office (for appointments etc.) via phone at
(480) 442-3990.
Restore Vascular Pllc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Restore Vascular Pllc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1396452611.
Healthcare Provider's Profile
| Full Name | Restore Vascular Pllc |
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| Type | Facility |
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| Speciality | Phlebology |
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| Location | 18510 E San Tan Blvd Ste 115, Queen Creek, Arizona |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1396452611
- Provider Enumeration Date: 11/07/2022
- Last Update Date: 08/29/2023
Medicare PECOS Information:
- PECOS PAC ID: 3870963325
- Enrollment ID: O20221228001408
Medical Identifiers
Medical identifiers for Restore Vascular Pllc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1396452611 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111N00000X | Chiropractor | (* (Not Available)) | Secondary |
| 202K00000X | Phlebology | (* (Not Available)) | Primary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Restore Vascular Pllc acts as a billing entity for following providers:
| Provider Name | Edward A Smith |
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| Provider Type | Practitioner - Internal Medicine |
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| Provider Identifiers | NPI Number: 1821278896
PECOS PAC ID: 7911130877
Enrollment ID: I20140429001764 |
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| Provider Name | Robin L Crilly |
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| Provider Type | Practitioner - Chiropractic |
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| Provider Identifiers | NPI Number: 1679627491
PECOS PAC ID: 1850319807
Enrollment ID: I20190920001280 |
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| Provider Name | Claudia Macias |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1508496167
PECOS PAC ID: 3577992916
Enrollment ID: I20200406001272 |
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| Provider Name | Matthew Derrick Miller |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1053926410
PECOS PAC ID: 8820404924
Enrollment ID: I20210316001725 |
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| Provider Name | Jeremy D Taylor |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1801580782
PECOS PAC ID: 3971963927
Enrollment ID: I20230721002166 |
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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. Restore Vascular Pllc 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 |
|---|
Restore Vascular Pllc
18510 E San Tan Blvd Ste 115,
Queen Creek, AZ 85142-2206
Ph: (480) 442-3990 | Restore Vascular Pllc
18510 E San Tan Blvd Ste 115,
Queen Creek, AZ 85142-2206
Ph: (480) 442-3990 |
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