Mrs Dallas Jordan Davis Provence, NP - Medicare Dermatology in Memphis, TN

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Mrs Dallas Jordan Davis Provence, NP is a medicare enrolled "Dermatology - Dermatopathology" physician in Memphis, Tennessee. Her current practice location is 6254 Poplar Ave, Memphis, Tennessee. You can reach out to her office (for appointments etc.) via phone at (901) 624-3333.

Mrs Dallas Jordan Davis Provence is licensed to practice in Tennessee (license number 28973) 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 1619556230.

Contact Information

Mrs Dallas Jordan Davis Provence, NP
6254 Poplar Ave,
Memphis, TN 38119-4713
(901) 624-3333
Not Available

Map and Direction




Physician's Profile

Full NameMrs Dallas Jordan Davis Provence
GenderFemale
SpecialityDermatology - Dermatopathology
Location6254 Poplar Ave, Memphis, Tennessee
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1619556230
  • Provider Enumeration Date: 04/02/2021
  • Last Update Date: 04/02/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 4688079338
  • Enrollment ID: I20210819000167

Medical Identifiers

Medical identifiers for Mrs Dallas Jordan Davis Provence such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1619556230NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207ND0900XDermatology - Dermatopathology 28973 (Tennessee)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. Mrs Dallas Jordan Davis Provence allows following entities to bill medicare on her behalf.
Entity NameLevy Dermatology, Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1508007790
PECOS PAC ID: 9032263538
Enrollment ID: O20090818000680

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. Mrs Dallas Jordan Davis Provence 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 AddressPractice Location Address
Mrs Dallas Jordan Davis Provence, NP
295 Pandora St,
Memphis, TN 38117-2854

Ph: (901) 338-1340		Mrs Dallas Jordan Davis Provence, NP
6254 Poplar Ave,
Memphis, TN 38119-4713

Ph: (901) 624-3333

Reviews and Comments


Dermatology Doctors in Memphis, TN

Dr. Emily T. Overholser, M.D.
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Practice Location: 1455 Union Ave, Memphis, TN 38104
Phone: 901-726-6655    Fax: 901-726-9056
Dr. Maureen Poh, MD
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Practice Location: 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132
Phone: 901-448-2300    Fax: 901-448-6657
Dr. Robert B Skinner, MD
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Practice Location: 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132
Phone: 901-448-2300    Fax: 901-448-6657
Dr. Mark Harris Tanenbaum, MD
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Medicare: Not Enrolled in Medicare
Practice Location: 760 Brookhaven Circle, Memphis, TN 38117
Phone: 901-761-0500    Fax: 901-761-0537
Dr. Alan Harris Tanenbaum, M.D.
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Practice Location: 760 E Brookhaven Cir, Memphis, TN 38117
Phone: 901-761-0500    
Dr. Courtney Stroupe Woodmansee, MD
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Medicare: Accepting Medicare Assignments
Practice Location: 1455 Union Ave, Memphis, TN 38104
Phone: 901-726-6655    
Dr. Srinidhi Reddy Pulusani, MD
Dermatology
Medicare: Medicare Enrolled
Practice Location: 930 Madison Ave Ste 801, Memphis, TN 38103
Phone: 901-866-8805    Fax: 901-302-2790

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

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