Susan Kelly Niebaum, PMHNP-BC in South Salt Lake, UT

Susan Kelly Niebaum, PMHNP-BC is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in South Salt Lake, Utah. Her current practice location is 408 E Kelsey View Ln, South Salt Lake, Utah. You can reach out to her office (for appointments etc.) via phone at (406) 212-2177.

Susan Kelly Niebaum is licensed to practice in Utah (license number 12585557-4405) 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 1861165839.

Contact Information

	Susan Kelly Niebaum, PMHNP-BC
	408 E Kelsey View Ln, South Salt Lake, UT 84115-4979
	(406) 212-2177
	Not Available

Map and Direction

Provider's Profile

Full Name	Susan Kelly Niebaum
Gender	Female
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	408 E Kelsey View Ln, South Salt Lake, Utah
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1861165839
Provider Enumeration Date: 07/27/2021
Last Update Date: 02/03/2022

Medicare PECOS Information:

PECOS PAC ID: 7911349352
Enrollment ID: I20240530001530

Medical Identifiers

Medical identifiers for Susan Kelly Niebaum such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1861165839	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	12585557-4405 (Utah)	Primary
163WP0807X	Registered Nurse - Psychiatric/mental Health, Child & Adolescent	16869 (Montana)	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. Susan Kelly Niebaum allows following entities to bill medicare on her behalf.

Entity Name	Karen W. Malm, Ph.d., P.c.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1871701656 PECOS PAC ID: 4284732835 Enrollment ID: O20070723000349

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. Susan Kelly Niebaum 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
Susan Kelly Niebaum, PMHNP-BC 408 E Kelsey View Ln, South Salt Lake, UT 84115-4979 Ph: (406) 212-2177	Susan Kelly Niebaum, PMHNP-BC 408 E Kelsey View Ln, South Salt Lake, UT 84115-4979 Ph: (406) 212-2177

Reviews and Comments

Nurse Practitioner Nurses in South Salt Lake, UT

Jennifer Michelle Sorto, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3702 S State St Ste 107, South Salt Lake, UT 84115 Phone: 801-288-2634 Fax: 801-288-1186
Jennifer Nicole Twohig, DNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3702 S State St Ste 107, South Salt Lake, UT 84115 Phone: 801-288-2634 Fax: 801-288-1186
Adam Thomas Creer, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2880 S Main St Ste 108, South Salt Lake, UT 84115 Phone: 240-356-1000
Kristen Cox, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 571 E Farmer Alumni Dr, South Salt Lake, UT 84106 Phone: 385-227-2897
Zhan Wang, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3702 S State St Ste 107, South Salt Lake, UT 84115 Phone: 801-288-2634 Fax: 801-288-1186
Leigh-andrew Thomas Sampson-seitz, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3269 S Main St Ste 220, South Salt Lake, UT 84115 Phone: 801-656-7124 Fax: 385-243-3021
Dr. Emily Elizabeth Barrows, DNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 447 W Bearcat Dr, South Salt Lake, UT 84115 Phone: 801-355-2846

Susan Kelly Niebaum, PMHNP-BC - Medicare Nurse Practitioner in South Salt Lake, UT