Praveen Kumar Mambalam, MD in Edmonds, WA

Praveen Kumar Mambalam, MD is a medicare enrolled "Anesthesiology - Pain Medicine" physician in Edmonds, Washington. He graduated from medical school in 2004 and has 22 years of diverse experience with area of expertise as Anesthesiology. He is a member of the group practice Pain And Spine Specialists Of Maryland Llc, Washington Pain And Spine Specialists Llc, Pain And Spine Specialists Of Maryland Llc, Pain And Spine Specialists Of Maryland Llc, Pain Care Physicians Pllc and his current practice location is 21616 76th Ave W, Ste 102, Edmonds, Washington. You can reach out to his office (for appointments etc.) via phone at (425) 774-1538.

Praveen Kumar Mambalam is licensed to practice in Washington (license number MD 00049423) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1790942886.

Contact Information

	Praveen Kumar Mambalam, MD
	21616 76th Ave W, Ste 102, Edmonds, WA 98026-7512
	(425) 774-1538
	(425) 744-1527

Map and Direction

Physician's Profile

Full Name	Praveen Kumar Mambalam
Gender	Male
Speciality	Anesthesiology
Experience	22 Years
Location	21616 76th Ave W, Edmonds, Washington
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Praveen Kumar Mambalam graduated from medical school in 2004

NPI Data:

NPI Number: 1790942886
Provider Enumeration Date: 05/17/2008
Last Update Date: 05/23/2023

Medicare PECOS Information:

PECOS PAC ID: 5597822387
Enrollment ID: I20240223002411

Medical Identifiers

Medical identifiers for Praveen Kumar Mambalam such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1790942886	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207LP2900X	Anesthesiology - Pain Medicine	MD 00049423 (Washington)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Providence St Peter Hospital	Olympia, WA	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Pain And Spine Specialists Of Maryland Llc	2668628124	31
Washington Pain And Spine Specialists Llc	7315381639	3
Pain And Spine Specialists Of Maryland Llc	2668628124	31
Pain And Spine Specialists Of Maryland Llc	2668628124	31
Pain Care Physicians Pllc	9537448931	12

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. Praveen Kumar Mambalam allows following entities to bill medicare on his behalf.

Entity Name	Simcare Asc Llc
Entity Type	Part B Supplier - Ambulatory Surgical Center
Entity Identifiers	NPI Number: 1538427943 PECOS PAC ID: 1951557594 Enrollment ID: O20120814000231

Entity Name	Pain And Spine Specialists Of Maryland Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1174884258 PECOS PAC ID: 2668628124 Enrollment ID: O20120816000109

Entity Name	Elkridge Asc, Llc
Entity Type	Part B Supplier - Ambulatory Surgical Center
Entity Identifiers	NPI Number: 1487169769 PECOS PAC ID: 2860752441 Enrollment ID: O20180130000354

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. Praveen Kumar Mambalam 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
Praveen Kumar Mambalam, MD Po Box 827, Bellevue, WA 98009-0827 Ph: (425) 774-1538	Praveen Kumar Mambalam, MD 21616 76th Ave W, Ste 102, Edmonds, WA 98026-7512 Ph: (425) 774-1538

Reviews and Comments

Anesthesiology Doctors in Edmonds, WA

Babu Rajendran, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 21601 76th Ave W, Edmonds, WA 98026 Phone: 425-640-4000 Fax: 206-672-0211
Emerly Tran Hoang Luong, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 21601 76th Ave W, Edmonds, WA 98026 Phone: 425-640-4000
Carolyn G. Miller, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 21601 76th Ave W, Edmonds, WA 98026 Phone: 425-640-4000 Fax: 206-672-0211
Brendan Rhodes O'donnell, Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 21616 76th W Ave, Suite 209, Edmonds, WA 98026 Phone: 425-774-5163 Fax: 425-744-1705
David Inadomi, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 21601 76th Ave W, Edmonds, WA 98026 Phone: 425-640-4000 Fax: 206-672-0211
Patrick Cheng-ann Lee, Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 21601 76th Ave W, Edmonds, WA 98026 Phone: 425-640-4000
Ms. Jessica Kristine Lee, Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 21601 76th Ave W, Edmonds, WA 98026 Phone: 425-640-4000

Praveen Kumar Mambalam, MD - Medicare Anesthesiology in Edmonds, WA