John Keane Iv, LMSW,BA is a medicare enrolled "Social Worker - Clinical" provider in Waterbury, Connecticut. His current practice location is
402 E Main St, Waterbury Op Adult Services, Waterbury, Connecticut. You can reach out to his office (for appointments etc.) via phone at
(203) 755-1143.
John Keane Iv is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1679900765.
Healthcare Provider's Profile
| Full Name | John Keane Iv |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 402 E Main St, Waterbury, Connecticut |
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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: 1679900765
- Provider Enumeration Date: 10/03/2013
- Last Update Date: 06/02/2020
Medicare PECOS Information:
- PECOS PAC ID: 4789062589
- Enrollment ID: I20220607002588
Medical Identifiers
Medical identifiers for John Keane Iv such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1679900765 | NPI | - | NPPES |
| PENDING | Other | CT | AETNA BEHAVIORAL HEALTH |
| 008064408 | Medicaid | CT | |
| 060669107 | Other | CT | OPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY |
| 060669107 | Other | CT | HEALTHYCT WELLMORE GRP/FACILITY |
| NOT ELIGIBLE | Other | CT | MHN TRICARE NORTH |
| 060669107 | Other | CT | UBH-CONNECTICARE WELLMORE GRP/FACILITY |
| 060669107 | Other | CT | ANTHEM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| PENDING | Other | CT | CIGNA BEHAVIORAL HEALTH |
| 13671836 | Other | CT | CAQH |
| D339123 WATERBURY | Other | CT | BEACON HEALTH STRATEGIES |
| NOT ELIGIBLE | Other | CT | MHN MANAGED HEALTH NETWORK |
| 060669107 | Other | CT | UBH-OXFORD FREEDOM/LIBERTY |
| 060669107 | Other | CT | UBH-UNITED HEALTHCARE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | 2166 (Connecticut) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | 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. John Keane Iv allows following entities to bill medicare on his behalf.
| Entity Name | Behavioral Health And Wellness Solutions Of Ct Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1114479888
PECOS PAC ID: 5395020945
Enrollment ID: O20170321002521 |
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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. John Keane Iv 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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John Keane Iv, LMSW,BA
141 E Main St, 4th Floor Administration,
Waterbury, CT 06702-2310
Ph: (203) 574-9000 | John Keane Iv, LMSW,BA
402 E Main St, Waterbury Op Adult Services,
Waterbury, CT 06702-1701
Ph: (203) 755-1143 |
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