Dedra Wallace, in Pueblo, CO - Medicare Counselor Provider

Dedra Wallace, is a medicare enrolled "Counselor - Professional" provider in Pueblo, Colorado. Her current practice location is 1302 Chinook Ln, Pueblo, Colorado. You can reach out to her office (for appointments etc.) via phone at (719) 545-2746.

Dedra Wallace is licensed to practice in Colorado (license number LPC.0013214) 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 1063810877.

Contact Information

	Dedra Wallace,
	1302 Chinook Ln, Pueblo, CO 81001-1851
	(719) 545-2746
	(719) 545-4100

Map and Direction

Healthcare Provider's Profile

Full Name	Dedra Wallace
Gender	Female
Speciality	Counselor - Professional
Location	1302 Chinook Ln, Pueblo, Colorado
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1063810877
Provider Enumeration Date: 12/10/2014
Last Update Date: 10/19/2016

Medicare PECOS Information:

PECOS PAC ID: 4486005345
Enrollment ID: I20240104004874

Medical Identifiers

Medical identifiers for Dedra Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1063810877	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YP2500X	Counselor - Professional	LPC.0013214 (Colorado)	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. Dedra Wallace allows following entities to bill medicare on her behalf.

Entity Name	Health Solutions
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1033165527 PECOS PAC ID: 0143110668 Enrollment ID: O20040318000467

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. Dedra Wallace 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
Dedra Wallace, 41 Montebello Road, Suite 200, Pueblo, CO 81004-1128 Ph: (719) 545-2746	Dedra Wallace, 1302 Chinook Ln, Pueblo, CO 81001-1851 Ph: (719) 545-2746

Reviews and Comments

Counselor in Pueblo, CO

Mr. Darren Mitchell Speier, BS CAC II Counselor Medicare: Not Enrolled in Medicare Practice Location: 509 E 13th St, Pueblo, CO 81001 Phone: 719-546-6666 Fax: 719-543-7764
Penelope Hyland, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1026 W Abriendo Ave, Pueblo, CO 81004 Phone: 719-545-2746 Fax: 719-545-4100
Melissa Mahan Hall, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1026 W Abriendo Ave, Pueblo, CO 81004 Phone: 719-545-2746 Fax: 719-545-4100
Jaycob Gonzales-cordova, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1302 Chinook Ln, Pueblo, CO 81001 Phone: 719-545-2746 Fax: 719-423-1882
James Ryan Hall, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1304 Chinook Ln, Pueblo, CO 81001 Phone: 719-545-2746 Fax: 719-584-0110
Felicia Gray, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1591 Taos Rd, Pueblo, CO 81006 Phone: 719-545-2746
Stanley Schleifer, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1304 Chinook Ln, Pueblo, CO 81001 Phone: 719-545-2746 Fax: 719-584-0119

Dedra Wallace, - Medicare Counselor in Pueblo, CO