Dr Glenn David Tanita, DMH in Sierra Vista, AZ - Medicare Psychologist Provider

Dr Glenn David Tanita, DMH is a medicare enrolled "Psychologist" provider in Sierra Vista, Arizona. His current practice location is 77 Calle Portal Ste C240, Sierra Vista, Arizona. You can reach out to his office (for appointments etc.) via phone at (520) 459-3011.

Dr Glenn David Tanita is licensed to practice in Arizona (license number 1249) 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 1669632006.

Contact Information

	Dr Glenn David Tanita, DMH
	77 Calle Portal Ste C240, Sierra Vista, AZ 85635-2986
	(520) 459-3011
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Glenn David Tanita
Gender	Male
Speciality	Psychologist
Location	77 Calle Portal Ste C240, Sierra Vista, Arizona
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1669632006
Provider Enumeration Date: 06/10/2008
Last Update Date: 02/20/2024

Medicare PECOS Information:

PECOS PAC ID: 6002705977
Enrollment ID: I20211124001606

Medical Identifiers

Medical identifiers for Dr Glenn David Tanita such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1669632006	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	PSY-001249 (Arizona)	Secondary
103T00000X	Psychologist	1249 (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. Dr Glenn David Tanita allows following entities to bill medicare on his behalf.

Entity Name	Chiricahua Community Health Centers Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1942241443 PECOS PAC ID: 5395638878 Enrollment ID: O20040206000860

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. Dr Glenn David Tanita 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
Dr Glenn David Tanita, DMH 1205 N F Ave, Douglas, AZ 85607-1920 Ph: (520) 459-3110	Dr Glenn David Tanita, DMH 77 Calle Portal Ste C240, Sierra Vista, AZ 85635-2986 Ph: (520) 459-3011

Reviews and Comments

Psychologist in Sierra Vista, AZ

Amanda M Wood, ED.S. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3555 E Fry Blvd, Sierra Vista, AZ 85635 Phone: 520-515-2790
Mrs. Maureen Kathryn Potucek, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3555 E Fry Blvd, Sierra Vista, AZ 85635 Phone: 520-515-2790 Fax: 520-515-2726
Ms. Susan Breen, ED.S Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3555 E Fry Blvd, Sierra Vista, AZ 85635 Phone: 520-515-2790 Fax: 520-515-2726
Ms. Amy Williams, M. ED Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3101 Nichols Dr, Sierra Vista, AZ 85650 Phone: 623-383-0325
Dat Nguyen, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 345 Taylor Dr, Sierra Vista, AZ 85635 Phone: 520-417-2115
Dr. Casi Ellis Ruffo, ED.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3555 E Fry Blvd, Sierra Vista, AZ 85635 Phone: 520-515-2790 Fax: 520-515-2726

Dr Glenn David Tanita, DMH - Medicare Psychologist in Sierra Vista, AZ