Nicole Pena, DO is a medicare enrolled "Neuromusculoskeletal Medicine & Omm" physician in Fairfield, California. Her current practice location is
2201 Courage Dr, Fairfield, California. You can reach out to her office (for appointments etc.) via phone at
(707) 469-4640.
Nicole Pena is licensed to practice in California (license number 20A14813) 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 1811322274.
Physician's Profile
| Full Name | Nicole Pena |
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| Gender | Female |
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| Speciality | Neuromusculoskeletal Medicine & Omm |
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| Location | 2201 Courage Dr, Fairfield, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1811322274
- Provider Enumeration Date: 09/04/2013
- Last Update Date: 04/11/2022
Medicare PECOS Information:
- PECOS PAC ID: 2668744806
- Enrollment ID: I20220518000773
Medical Identifiers
Medical identifiers for Nicole Pena such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1811322274 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 204D00000X | Neuromusculoskeletal Medicine & Omm | 20A14813 (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. Nicole Pena allows following entities to bill medicare on her behalf.
| Entity Name | Lifelong Medical Care |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1689670002 PECOS PAC ID: 2062304538 Enrollment ID: O20050713000704 |
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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. Nicole Pena 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 |
Nicole Pena, DO 1310 Club Dr, Vallejo, CA 94592-1187 Ph: (707) 638-5217 | Nicole Pena, DO 2201 Courage Dr, Fairfield, CA 94533-6733 Ph: (707) 469-4640 |
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