Dr Patrice Nicole Douglas, LP, LMFT is a medicare enrolled "Psychologist - Clinical" provider in Rancho Cucamonga, California. Her current practice location is
11175 Azusa Ct Ste 110, Rancho Cucamonga, California. You can reach out to her office (for appointments etc.) via phone at
(909) 705-0773.
Dr Patrice Nicole Douglas is licensed to practice in California (license number 34948) 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 1275911257.
Healthcare Provider's Profile
| Full Name | Dr Patrice Nicole Douglas |
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| Gender | Female |
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| Speciality | Psychologist - Clinical |
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| Location | 11175 Azusa Ct Ste 110, Rancho Cucamonga, 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: 1275911257
- Provider Enumeration Date: 05/11/2015
- Last Update Date: 10/16/2024
Medicare PECOS Information:
- PECOS PAC ID: 5597299123
- Enrollment ID: I20241105002919
Medical Identifiers
Medical identifiers for Dr Patrice Nicole Douglas such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1275911257 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | 34948 (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. Dr Patrice Nicole Douglas allows following entities to bill medicare on her behalf.
| Entity Name | Thrive Psychological Services Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1528640026
PECOS PAC ID: 1658744974
Enrollment ID: O20230307000584 |
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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 Patrice Nicole Douglas 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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Dr Patrice Nicole Douglas, LP, LMFT
8350 Archibald Ave Ste 100,
Rancho Cucamonga, CA 91730-3670
Ph: (909) 705-0773 | Dr Patrice Nicole Douglas, LP, LMFT
11175 Azusa Ct Ste 110,
Rancho Cucamonga, CA 91730-4933
Ph: (909) 705-0773 |
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