Richard Ettelson, PHD in Rancho Cucamonga, CA - Medicare Psychologist Provider

Richard Ettelson, PHD is a medicare enrolled "Psychologist - Clinical" provider in Rancho Cucamonga, California. His current practice location is 10630 Town Center Dr Ste 120, Rancho Cucamonga, California. You can reach out to his office (for appointments etc.) via phone at (909) 989-0901.

Richard Ettelson is licensed to practice in California (license number D5418953) 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 1174569453.

Contact Information

	Richard Ettelson, PHD
	10630 Town Center Dr Ste 120, Rancho Cucamonga, CA 91730-6889
	(909) 989-0901
	(909) 941-1087

Map and Direction

Healthcare Provider's Profile

Full Name	Richard Ettelson
Gender	Male
Speciality	Psychologist - Clinical
Location	10630 Town Center Dr Ste 120, Rancho Cucamonga, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1174569453
Provider Enumeration Date: 06/22/2006
Last Update Date: 09/18/2018

Medicare PECOS Information:

PECOS PAC ID: 6507298080
Enrollment ID: I20191121002304

Medical Identifiers

Medical identifiers for Richard Ettelson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1174569453	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103TC0700X	Psychologist - Clinical	D5418953 (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. Richard Ettelson allows following entities to bill medicare on his behalf.

Entity Name	Memory Check Psychological Services, A Professional Corporation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1912184219 PECOS PAC ID: 7416856422 Enrollment ID: O20040107001021

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. Richard Ettelson 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
Richard Ettelson, PHD 10630 Town Center Dr Ste 120, Rancho Cucamonga, CA 91730-6889 Ph: (909) 989-0901	Richard Ettelson, PHD 10630 Town Center Dr Ste 120, Rancho Cucamonga, CA 91730-6889 Ph: (909) 989-0901

Reviews and Comments

Psychologist in Rancho Cucamonga, CA

Dr. Lauri Lee Rogers, PSY.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 9089 Baseline Rd, Suite 200, Rancho Cucamonga, CA 91730 Phone: 909-980-3567 Fax: 909-989-3932
Victor Cordova, PSY.D Psychologist Medicare: Medicare Enrolled Practice Location: 9033 Base Line Rd Ste A, Rancho Cucamonga, CA 91730 Phone: 909-922-2442 Fax: 909-999-2377
Dr. Scott Su, PHD Psychologist Medicare: Accepting Medicare Assignments Practice Location: 8300 Utica Ave Ste 245, Rancho Cucamonga, CA 91730 Phone: 909-247-5992
Dr. Krystle Rose Frazier-philo, ED.D. Psychologist Medicare: Medicare Enrolled Practice Location: 9600 Center Ave Ste 160, Rancho Cucamonga, CA 91730 Phone: 800-434-8923
Veronica Nakla, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 9377 Haven Ave Ste 100, Rancho Cucamonga, CA 91730 Phone: 909-906-1505
Dr. Stacey Waring, PSY.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 9500 Etiwanda Ave, Rancho Cucamonga, CA 91739 Phone: 909-463-5179
Dr. Jerry M Goffman, PHD. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 8253 White Oak Ave, Rancho Cucamonga, CA 91730 Phone: 951-312-1041

Richard Ettelson, PHD - Medicare Psychologist in Rancho Cucamonga, CA