Diana Bastidas Vallejo, MSW, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Tallahassee, Florida. Her current practice location is
1713 Mahan Dr, Tallahassee, Florida. You can reach out to her office (for appointments etc.) via phone at
(850) 681-6001.
Diana Bastidas Vallejo is licensed to practice in Florida (license number SW23714) 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 1902629660.
Healthcare Provider's Profile
| Full Name | Diana Bastidas Vallejo |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 1713 Mahan Dr, Tallahassee, Florida |
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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: 1902629660
- Provider Enumeration Date: 11/01/2024
- Last Update Date: 11/01/2024
Medicare PECOS Information:
- PECOS PAC ID: 3577081694
- Enrollment ID: I20250513001632
Medical Identifiers
Medical identifiers for Diana Bastidas Vallejo such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1902629660 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | SW23714 (Florida) | Secondary |
| 101YP2500X | Counselor - Professional | SW23714 (Florida) | Secondary |
| 102L00000X | Psychoanalyst | SW23714 (Florida) | Secondary |
| 104100000X | Social Worker | SW23714 (Florida) | Secondary |
| 1041C0700X | Social Worker - Clinical | SW23714 (Florida) | 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. Diana Bastidas Vallejo allows following entities to bill medicare on her behalf.
| Entity Name | Grow Healthcare Group Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1245845932
PECOS PAC ID: 3476961368
Enrollment ID: O20210414000053 |
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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. Diana Bastidas Vallejo 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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Diana Bastidas Vallejo, MSW, LCSW
87061 Farnsworth Ln,
Yulee, FL 32097-3606
Ph: () - | Diana Bastidas Vallejo, MSW, LCSW
1713 Mahan Dr,
Tallahassee, FL 32308-1218
Ph: (850) 681-6001 |
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