Antonio R Diaz Jr, MD is a medicare enrolled "Psychiatry & Neurology - Psychiatry" physician in Logan, West Virginia. His current practice location is
174 Lmah Center Rd, Logan, West Virginia. You can reach out to his office (for appointments etc.) via phone at
(304) 792-7130.
Antonio R Diaz Jr is licensed to practice in West Virginia (license number 16814) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1053339135.
Physician's Profile
| Full Name | Antonio R Diaz Jr |
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| Gender | Male |
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| Speciality | Psychiatry & Neurology - Psychiatry |
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| Location | 174 Lmah Center Rd, Logan, West Virginia |
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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: 1053339135
- Provider Enumeration Date: 07/17/2006
- Last Update Date: 08/19/2021
Medicare PECOS Information:
- PECOS PAC ID: 1557315199
- Enrollment ID: I20050308000284
Medical Identifiers
Medical identifiers for Antonio R Diaz Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1053339135 | NPI | - | NPPES |
| 0288291 | Medicaid | OH | |
| 1493983 | Other | WV | UMWA |
| 550751751 | Other | WV | BLUE CROSS/BLUE SHIELD |
| 64940489 | Medicaid | KY | |
| 000706447 | Other | | BLUE CROSS/BLUE SHIELD |
| 0115148000 | Medicaid | WV | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 16814 (West Virginia) | 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. Antonio R Diaz Jr allows following entities to bill medicare on his behalf.
| Entity Name | Logan Mingo Area Mental Health, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1427522218
PECOS PAC ID: 0840240362
Enrollment ID: O20190620002377 |
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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. Antonio R Diaz Jr 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 |
|---|
Antonio R Diaz Jr, MD
Po Box 176,
Logan, WV 25601-0176
Ph: (304) 792-7130 | Antonio R Diaz Jr, MD
174 Lmah Center Rd,
Logan, WV 25601-4058
Ph: (304) 792-7130 |
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