Kennyanna Jefferson, is a medicare enrolled "Social Worker - Clinical" provider in Fontana, California. Her current practice location is
17053 Foothill Blvd, Fontana, California. You can reach out to her office (for appointments etc.) via phone at
(909) 347-1300.
Kennyanna Jefferson is licensed to practice in California (license number 127688) 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 1114540598.
Healthcare Provider's Profile
| Full Name | Kennyanna Jefferson |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 17053 Foothill Blvd, Fontana, California |
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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: 1114540598
- Provider Enumeration Date: 05/20/2020
- Last Update Date: 12/27/2024
Medicare PECOS Information:
- PECOS PAC ID: 7618499096
- Enrollment ID: I20250314000435
Medical Identifiers
Medical identifiers for Kennyanna Jefferson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1114540598 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | 102016 (California) | Secondary |
| 104100000X | Social Worker | ASW102016 (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | 127688 (California) | 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. Kennyanna Jefferson allows following entities to bill medicare on her behalf.
| Entity Name | Community Health Systems Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1952308009
PECOS PAC ID: 7012824717
Enrollment ID: O20051117000822 |
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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. Kennyanna Jefferson 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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Kennyanna Jefferson,
850 E Foothill Blvd,
Rialto, CA 92376-5230
Ph: (909) 420-9472 | Kennyanna Jefferson,
17053 Foothill Blvd,
Fontana, CA 92335-3574
Ph: (909) 347-1300 |
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