Dr Jomary Sepulveda, LPC is a medicare enrolled "Psychologist" provider in New Haven, Connecticut. Her current practice location is
400 Columbus Ave, Apc, New Haven, Connecticut. You can reach out to her office (for appointments etc.) via phone at
(203) 503-3673.
Dr Jomary Sepulveda is licensed to practice in Connecticut (license number 4700) 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 1174974471.
Healthcare Provider's Profile
| Full Name | Dr Jomary Sepulveda |
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| Gender | Female |
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| Speciality | Psychologist |
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| Location | 400 Columbus Ave, New Haven, 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: 1174974471
- Provider Enumeration Date: 06/28/2016
- Last Update Date: 03/26/2024
Medicare PECOS Information:
- PECOS PAC ID: 8325481898
- Enrollment ID: I20240212003418
Medical Identifiers
Medical identifiers for Dr Jomary Sepulveda such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1174974471 | NPI | - | NPPES |
| 004235918 | Medicaid | CT | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YP2500X | Counselor - Professional | 3521 (Connecticut) | Secondary |
| 103T00000X | Psychologist | 4700 (Connecticut) | 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. Dr Jomary Sepulveda allows following entities to bill medicare on her behalf.
| Entity Name | Cornell Scott Hill Health Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1902921380
PECOS PAC ID: 3072418359
Enrollment ID: O20031201000145 |
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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. Dr Jomary Sepulveda 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 |
|---|
Dr Jomary Sepulveda, LPC
400 Columbus Ave, Credentialing Specialist,
New Haven, CT 06519-1233
Ph: (203) 503-3174 | Dr Jomary Sepulveda, LPC
400 Columbus Ave, Apc,
New Haven, CT 06519
Ph: (203) 503-3673 |
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