Jesse Wayne Coburn, LSCW, CADC II, SUDP is a medicare enrolled "Social Worker - Clinical" provider in Hill Afb, Utah. He graduated from healthcare school in 2019 and has 5 years of diverse experience with area of expertise as Psychiatry. He is a member of the group practice Harbor Youth And Family Counseling, Deborah A Christensen Phd And Associates, Inc and his current practice location is
7309 Balmer St, Hill Afb, Utah. You can reach out to his office (for appointments etc.) via phone at
(801) 777-7909.
Jesse Wayne Coburn is licensed to practice in Utah (license number 13486284-3501) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1902463086.
Healthcare Provider's Profile
| Full Name | Jesse Wayne Coburn |
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| Gender | Male |
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| Speciality | Psychiatry |
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| Experience | 5 Years |
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| Location | 7309 Balmer St, Hill Afb, Utah |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Jesse Wayne Coburn graduated from medical school in 2019
NPI Data:
- NPI Number: 1902463086
- Provider Enumeration Date: 05/23/2019
- Last Update Date: 03/26/2024
Medicare PECOS Information:
- PECOS PAC ID: 4688060593
- Enrollment ID: I20220920000448
Medical Identifiers
Medical identifiers for Jesse Wayne Coburn such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1902463086 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LW61327515 (Washington) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | 13486284-3501 (Utah) | Secondary |
| 101YM0800X | Counselor - Mental Health | A5574 (Oregon) | Secondary |
| 1041C0700X | Social Worker - Clinical | 13486284-3501 (Utah) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Harbor Youth And Family Counseling | 7012338981 | 24 |
| Deborah A Christensen Phd And Associates, Inc | 6901891498 | 12 |
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. Jesse Wayne Coburn allows following entities to bill medicare on his behalf.
| Entity Name | Harbor Youth And Family Counseling |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1205466265
PECOS PAC ID: 7012338981
Enrollment ID: O20200601002016 |
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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. Jesse Wayne Coburn 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 |
|---|
Jesse Wayne Coburn, LSCW, CADC II, SUDP
1640 Hislop Dr,
Ogden, UT 84404-5318
Ph: (208) 404-1501 | Jesse Wayne Coburn, LSCW, CADC II, SUDP
7309 Balmer St,
Hill Afb, UT 84056-5012
Ph: (801) 777-7909 |
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