Kadasha Fairclough, RN is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Loganville, Georgia. Her current practice location is
1340 Alexander Xing, Loganville, Georgia. You can reach out to her office (for appointments etc.) via phone at
(404) 916-9226.
Kadasha Fairclough is licensed to practice in Virginia (license number 0024190568) 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 1184260275.
Provider's Profile
| Full Name | Kadasha Fairclough |
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| Gender | Female |
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| Speciality | Nurse Anesthetist, Certified Registered |
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| Location | 1340 Alexander Xing, Loganville, Georgia |
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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: 1184260275
- Provider Enumeration Date: 11/23/2019
- Last Update Date: 12/06/2024
Medicare PECOS Information:
- PECOS PAC ID: 4284160169
- Enrollment ID: I20241216003099
Medical Identifiers
Medical identifiers for Kadasha Fairclough such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1184260275 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 163W00000X | Registered Nurse | RN286337 (Georgia) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 0024190568 (Virginia) | 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. Kadasha Fairclough allows following entities to bill medicare on her behalf.
| Entity Name | Northstar Anesthesia Of Virginia, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1194488791
PECOS PAC ID: 6608268826
Enrollment ID: O20220120002585 |
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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. Kadasha Fairclough 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 |
|---|
Kadasha Fairclough, RN
1340 Alexander Xing,
Loganville, GA 30052-3985
Ph: (404) 916-9226 | Kadasha Fairclough, RN
1340 Alexander Xing,
Loganville, GA 30052-3985
Ph: (404) 916-9226 |
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