Mrs Annette Van Dam, APRN is a medicare enrolled "Family Medicine - Adult Medicine" in Columbus, Ohio. Her current practice location is
21 E. State St. Office 233 Columbus, Oh 43215, Offixe 233, Columbus, Ohio. You can reach out to her office (for appointments etc.) via phone at
(888) 731-8994.
Mrs Annette Van Dam is licensed to practice in Kentucky (license number 3009783) 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 1376914192.
Provider's Profile
| Full Name | Mrs Annette Van Dam |
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| Gender | Female |
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| Speciality | Family Medicine - Adult Medicine |
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| Location | 21 E. State St. Office 233 Columbus, Oh 43215, Columbus, Ohio |
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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: 1376914192
- Provider Enumeration Date: 10/20/2015
- Last Update Date: 10/21/2025
Medicare PECOS Information:
- PECOS PAC ID: 9133420029
- Enrollment ID: I20151218000444
Medical Identifiers
Medical identifiers for Mrs Annette Van Dam such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1376914192 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | 3009783 (Kentucky) | Secondary |
| 208D00000X | General Practice | 3009783 (Kentucky) | Secondary |
| 207QA0505X | Family Medicine - Adult Medicine | 3009783 (Kentucky) | Primary |
| 202D00000X | Integrative Medicine | 3009783 (Kentucky) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 3009783 (Kentucky) | 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. Mrs Annette Van Dam allows following entities to bill medicare on her behalf.
| Entity Name | Brock Medical, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1023379815
PECOS PAC ID: 9830354638
Enrollment ID: O20120628000567 |
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| Entity Name | Concord Medical Group Of Kentucky Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1346746385
PECOS PAC ID: 9133483894
Enrollment ID: O20180503002233 |
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| Entity Name | Hospital Medicine Services Of Ky, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215634373
PECOS PAC ID: 0244695104
Enrollment ID: O20230427001527 |
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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. Mrs Annette Van Dam 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 |
|---|
Mrs Annette Van Dam, APRN
796 Ninevah Rd,
Frankfort, KY 40601-7960
Ph: (888) 731-8994 | Mrs Annette Van Dam, APRN
21 E. State St. Office 233 Columbus, Oh 43215, Offixe 233,
Columbus, OH 43215
Ph: (888) 731-8994 |
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