Kelly Susan Davis, in San Rafael, CA - Medicare Counselor Provider

Kelly Susan Davis, is a medicare enrolled "Counselor - Mental Health" provider in San Rafael, California. Her current practice location is 900 5th Ave, Suite 150, San Rafael, California. You can reach out to her office (for appointments etc.) via phone at (415) 457-6964.

Kelly Susan Davis is licensed to practice in * (Not Available) (license number ) 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 1093143554.

Contact Information

	Kelly Susan Davis,
	900 5th Ave, Suite 150, San Rafael, CA 94901-2959
	(415) 457-6964
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Kelly Susan Davis
Gender	Female
Speciality	Counselor - Mental Health
Location	900 5th Ave, San Rafael, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1093143554
Provider Enumeration Date: 10/21/2013
Last Update Date: 03/10/2025

Medicare PECOS Information:

PECOS PAC ID: 7618499195
Enrollment ID: I20250313004076

Medical Identifiers

Medical identifiers for Kelly Susan Davis such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1093143554	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
106H00000X	Marriage & Family Therapist	MT5113 (Florida)	Secondary
101YM0800X	Counselor - Mental Health	(* (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. Kelly Susan Davis allows following entities to bill medicare on her behalf.

Entity Name	Quality Bhs Florida Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1689297541 PECOS PAC ID: 4082030721 Enrollment ID: O20200812002561

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. Kelly Susan Davis 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
Kelly Susan Davis, 900 5th Ave, Suite 150, San Rafael, CA 94901-2959 Ph: (415) 457-6964	Kelly Susan Davis, 900 5th Ave, Suite 150, San Rafael, CA 94901-2959 Ph: (415) 457-6964

Reviews and Comments

Counselor in San Rafael, CA

Lisa Wynland Lukianoff, Counselor Medicare: Not Enrolled in Medicare Practice Location: 555 Northgate Dr, Family Service Agency Of Marin, San Rafael, CA 94903 Phone: 415-491-5700
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Mr. Scott B. Raymer, Counselor Medicare: Not Enrolled in Medicare Practice Location: 70 Skyview Ter, San Rafael, CA 94903 Phone: 415-491-0708
Mr. Daniel Alan Linder, MA, MFT Counselor Medicare: Not Enrolled in Medicare Practice Location: 710 C St, San Rafael, CA 94901 Phone: 415-456-0802

Kelly Susan Davis, - Medicare Counselor in San Rafael, CA