Mr Ephraim Tata Fombo, PMHNP-BC in San Antonio, TX

Mr Ephraim Tata Fombo, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in San Antonio, Texas. His current practice location is 3031 W Ih 10, Attn: Credentialing Dept, San Antonio, Texas. You can reach out to his office (for appointments etc.) via phone at (210) 261-1000.

Mr Ephraim Tata Fombo is licensed to practice in Texas (license number RN796897) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1134368327.

Contact Information

	Mr Ephraim Tata Fombo, PMHNP-BC
	3031 W Ih 10, Attn: Credentialing Dept, San Antonio, TX 78201-5159
	(210) 261-1000
	(210) 731-8678

Map and Direction

Provider's Profile

Full Name	Mr Ephraim Tata Fombo
Gender	Male
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	3031 W Ih 10, San Antonio, Texas
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1134368327
Provider Enumeration Date: 02/11/2009
Last Update Date: 11/08/2016

Medicare PECOS Information:

PECOS PAC ID: 2062793581
Enrollment ID: I20161221000980

Medical Identifiers

Medical identifiers for Mr Ephraim Tata Fombo such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1134368327	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163W00000X	Registered Nurse	RN 330129 (Ohio)	Secondary
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	RN796897 (Texas)	Primary
163W00000X	Registered Nurse	796897 (Texas)	Secondary

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. Mr Ephraim Tata Fombo allows following entities to bill medicare on his behalf.

Entity Name	Mypsych Mental Health, Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1871962191 PECOS PAC ID: 5890078042 Enrollment ID: O20170213002322

Entity Name	Royaltystar Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1306414313 PECOS PAC ID: 1850797978 Enrollment ID: O20210914003770

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. Mr Ephraim Tata Fombo 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
Mr Ephraim Tata Fombo, PMHNP-BC 3031 W Ih 10, San Antonio, TX 78201-5159 Ph: (210) 261-1000	Mr Ephraim Tata Fombo, PMHNP-BC 3031 W Ih 10, Attn: Credentialing Dept, San Antonio, TX 78201-5159 Ph: (210) 261-1000

Reviews and Comments

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Mr Ephraim Tata Fombo, PMHNP-BC - Medicare Nurse Practitioner in San Antonio, TX