Kirsty E Bortnik, PHD is a medicare enrolled "Clinical Neuropsychologist" provider in Santa Monica, California. Her current practice location is
1301 20th St Ste 150, Santa Monica, California. You can reach out to her office (for appointments etc.) via phone at
(310) 458-2764.
Kirsty E Bortnik is licensed to practice in California (license number 32126) 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 1376748780.
Healthcare Provider's Profile
| Full Name | Kirsty E Bortnik |
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| Gender | Female |
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| Speciality | Clinical Neuropsychologist |
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| Location | 1301 20th St Ste 150, Santa Monica, California |
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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: 1376748780
- Provider Enumeration Date: 06/15/2007
- Last Update Date: 01/09/2024
Medicare PECOS Information:
- PECOS PAC ID: 8820214778
- Enrollment ID: I20140729002268
Medical Identifiers
Medical identifiers for Kirsty E Bortnik such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1376748780 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 103TC0700X | Psychologist - Clinical | 32126 (California) | Secondary |
| 103TC0700X | Psychologist - Clinical | 019916 (New York) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 32126 (California) | 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. Kirsty E Bortnik allows following entities to bill medicare on her behalf.
| Entity Name | Epilepsy & Neurophysiology Medical Consulting Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1770564593
PECOS PAC ID: 4082500624
Enrollment ID: O20040223000404 |
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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. Kirsty E Bortnik 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 |
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Kirsty E Bortnik, PHD
Po Box 1493,
Sierra Madre, CA 91025-4493
Ph: (212) 305-3247 | Kirsty E Bortnik, PHD
1301 20th St Ste 150,
Santa Monica, CA 90404-2050
Ph: (310) 458-2764 |
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