Jacob Fantin, PLP is a medicare enrolled "Psychologist - Clinical" provider in Monett, Missouri. He graduated from medical school in 2022 and has 4 years of diverse experience with area of expertise as Clinical Psychologist. He is a member of the group practice Clark Community Mental Health Center and his current practice location is
1701 N Central Ave, Monett, Missouri. You can reach out to his office (for appointments etc.) via phone at
(417) 476-1000.
Jacob Fantin is licensed to practice in Missouri (license number 2022038992) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1538883459.
Healthcare Provider's Profile
| Full Name | Jacob Fantin |
|---|
| Gender | Male |
|---|
| Speciality | Clinical Psychologist |
|---|
| Experience | 4 Years |
|---|
| Location | 1701 N Central Ave, Monett, Missouri |
|---|
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Jacob Fantin graduated from medical school in 2022
NPI Data:
- NPI Number: 1538883459
- Provider Enumeration Date: 10/04/2022
- Last Update Date: 10/04/2022
Medicare PECOS Information:
- PECOS PAC ID: 1557711231
- Enrollment ID: I20231220003813
Medical Identifiers
Medical identifiers for Jacob Fantin such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1538883459 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 103TC0700X | Psychologist - Clinical | 2022038992 (Missouri) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
| Clark Community Mental Health Center | 8527069277 | 21 |
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. Jacob Fantin allows following entities to bill medicare on his behalf.
| Entity Name | Clark Community Mental Health Center |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1801807771 PECOS PAC ID: 8527069277 Enrollment ID: O20070123000267 |
|---|
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. Jacob Fantin 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 |
Jacob Fantin, PLP Po Box 100, Pierce City, MO 65723-2100 Ph: (417) 476-1013 | Jacob Fantin, PLP 1701 N Central Ave, Monett, MO 65708-9999 Ph: (417) 476-1000 |
Reviews and Comments