Nicole Burgos, is a medicare enrolled "Social Worker - Clinical" provider in Santa Fe Springs, California. Her current practice location is
11731 Telegraph Rd, Santa Fe Springs, California. You can reach out to her office (for appointments etc.) via phone at
(562) 907-7429.
Nicole Burgos is licensed to practice in California (license number LCSW118331) 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 1386150795.
Healthcare Provider's Profile
| Full Name | Nicole Burgos |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 11731 Telegraph Rd, Santa Fe Springs, 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: 1386150795
- Provider Enumeration Date: 12/20/2017
- Last Update Date: 11/29/2023
Medicare PECOS Information:
- PECOS PAC ID: 6305299538
- Enrollment ID: I20240124002313
Medical Identifiers
Medical identifiers for Nicole Burgos such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1386150795 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | ASW80980 (California) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | ASW80980 (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | LCSW118331 (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. Nicole Burgos allows following entities to bill medicare on her behalf.
| Entity Name | Pacific Clinics |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1255496105
PECOS PAC ID: 4082008420
Enrollment ID: O20220228001926 |
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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. Nicole Burgos 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 |
|---|
Nicole Burgos,
5112 Pine Ave,
Long Beach, CA 90805-6442
Ph: (562) 706-3333 | Nicole Burgos,
11731 Telegraph Rd,
Santa Fe Springs, CA 90670-3675
Ph: (562) 907-7429 |
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