Camillia Clark, COUI-9541 in Idaho Falls, ID - Medicare Counselor Provider

Camillia Clark, COUI-9541 is a medicare enrolled "Counselor - Mental Health" provider in Idaho Falls, Idaho. Her current practice location is 452 D St, Idaho Falls, Idaho. You can reach out to her office (for appointments etc.) via phone at (208) 552-0355.

Camillia Clark is licensed to practice in Idaho (license number COUI-9541) 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 1528840584.

Contact Information

	Camillia Clark, COUI-9541
	452 D St, Idaho Falls, ID 83402-3531
	(208) 552-0355
	(208) 200-3201

Map and Direction

Healthcare Provider's Profile

Full Name	Camillia Clark
Gender	Female
Speciality	Counselor - Mental Health
Location	452 D St, Idaho Falls, Idaho
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1528840584
Provider Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023

Medicare PECOS Information:

PECOS PAC ID: 6709311509
Enrollment ID: I20241202003257

Medical Identifiers

Medical identifiers for Camillia Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1528840584	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YM0800X	Counselor - Mental Health	COUI-9541 (Idaho)	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. Camillia Clark allows following entities to bill medicare on her behalf.

Entity Name	Vista Family Services Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1235353251 PECOS PAC ID: 8022230689 Enrollment ID: O20141114001164

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. Camillia Clark 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
Camillia Clark, COUI-9541 452 D St, Idaho Falls, ID 83402-3531 Ph: (208) 552-0355	Camillia Clark, COUI-9541 452 D St, Idaho Falls, ID 83402-3531 Ph: (208) 552-0355

Reviews and Comments

Counselor in Idaho Falls, ID

Desiree Jenks-asay, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 615 Hoopes Ave, Idaho Falls, ID 83401 Phone: 208-542-0352
Kelsey Lynn Cole, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 211 S Woodruff Ave Ste A3, Idaho Falls, ID 83401 Phone: 208-524-4818 Fax: 208-522-6630
Steven Orme, LCSW Counselor Medicare: Medicare Enrolled Practice Location: 545 Shoup Ave, Idaho Falls, ID 83402 Phone: 208-351-1447
Mckenzie Leigh Duncan, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1262 E 17th St, Idaho Falls, ID 83404 Phone: 208-346-0688 Fax: 208-620-3027
Mr. Jorge Padron, CADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 543 3rd St, Idaho Falls, ID 83401 Phone: 208-522-6925 Fax: 208-522-6934
Zachary Wixom, LMSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 150 Shoup Ave, Idaho Falls, ID 83402 Phone: 208-528-5712
Jennie R Nelson, Counselor Medicare: Medicare Enrolled Practice Location: 115 E 16th St, Idaho Falls, ID 83404 Phone: 208-523-6727

Camillia Clark, COUI-9541 - Medicare Counselor in Idaho Falls, ID