Chantal I Dalencour, MD is a medicare enrolled "Pediatrics" physician in North Ridgeville, Ohio. Her current practice location is
34960 Center Ridge Rd, North Ridgeville, Ohio. You can reach out to her office (for appointments etc.) via phone at
(440) 353-3433.
Chantal I Dalencour is licensed to practice in Ohio (license number 35073965) 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 1265434120.
Physician's Profile
| Full Name | Chantal I Dalencour |
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| Gender | Female |
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| Speciality | Pediatrics |
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| Location | 34960 Center Ridge Rd, North Ridgeville, Ohio |
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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: 1265434120
- Provider Enumeration Date: 08/11/2005
- Last Update Date: 11/17/2020
Medicare PECOS Information:
- PECOS PAC ID: 5991846081
- Enrollment ID: I20100112000348
Medical Identifiers
Medical identifiers for Chantal I Dalencour such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1265434120 | NPI | - | NPPES |
| 2095021 | Medicaid | OH | |
| 370017680 | Other | OH | RR MEDICARE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | 35073965 (Ohio) | 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. Chantal I Dalencour allows following entities to bill medicare on her behalf.
| Entity Name | University Primary Care Practices Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1003935339
PECOS PAC ID: 3072417534
Enrollment ID: O20031125000767 |
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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. Chantal I Dalencour 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 |
|---|
Chantal I Dalencour, MD
26908 Detroit Rd, Suite 301,
Westlake, OH 44145-2398
Ph: (440) 617-1823 | Chantal I Dalencour, MD
34960 Center Ridge Rd,
North Ridgeville, OH 44039-3183
Ph: (440) 353-3433 |
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