Cheryl Ann Countryman, is a medicare enrolled "Nurse Practitioner - Acute Care" in Tonopah, Arizona. Her current practice location is
5122 N 382nd Ave, Tonopah, Arizona. You can reach out to her office (for appointments etc.) via phone at
(160) 237-7811.
Cheryl Ann Countryman is licensed to practice in Arizona (license number 245602) 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 1295593697.
Provider's Profile
| Full Name | Cheryl Ann Countryman |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Acute Care |
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| Location | 5122 N 382nd Ave, Tonopah, Arizona |
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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: 1295593697
- Provider Enumeration Date: 03/11/2024
- Last Update Date: 03/11/2024
Medicare PECOS Information:
- PECOS PAC ID: 2668997164
- Enrollment ID: I20250417000182
Medical Identifiers
Medical identifiers for Cheryl Ann Countryman such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1295593697 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LA2100X | Nurse Practitioner - Acute Care | 245602 (Arizona) | 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. Cheryl Ann Countryman allows following entities to bill medicare on her behalf.
| Entity Name | Southeastern Physician Services Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1083835441
PECOS PAC ID: 0042307852
Enrollment ID: O20090715000150 |
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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. Cheryl Ann Countryman 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 |
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Cheryl Ann Countryman,
5122 N 382nd Ave,
Tonopah, AZ 85354-0140
Ph: (160) 237-7811 | Cheryl Ann Countryman,
5122 N 382nd Ave,
Tonopah, AZ 85354-0140
Ph: (160) 237-7811 |
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