Stella Dimaris Cruz Rodriguez, PSYD is a medicare enrolled "Psychologist" provider in Mableton, Georgia. Her current practice location is
1025 Veterans Memorial Hwy Se Ste 660, Mableton, Georgia. You can reach out to her office (for appointments etc.) via phone at
(470) 568-3611.
Stella Dimaris Cruz Rodriguez is licensed to practice in Georgia (license number PSY004432) 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 1578162970.
Healthcare Provider's Profile
| Full Name | Stella Dimaris Cruz Rodriguez |
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| Gender | Female |
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| Speciality | Psychologist |
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| Location | 1025 Veterans Memorial Hwy Se Ste 660, Mableton, Georgia |
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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: 1578162970
- Provider Enumeration Date: 10/19/2020
- Last Update Date: 11/20/2024
Medicare PECOS Information:
- PECOS PAC ID: 8224440490
- Enrollment ID: I20201211000478
Medical Identifiers
Medical identifiers for Stella Dimaris Cruz Rodriguez such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1578162970 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 103T00000X | Psychologist | PSY004432 (Georgia) | 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. Stella Dimaris Cruz Rodriguez allows following entities to bill medicare on her behalf.
| Entity Name | The Southeast Permanente Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1245266956
PECOS PAC ID: 6204829013
Enrollment ID: O20040407000370 |
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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. Stella Dimaris Cruz Rodriguez 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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Stella Dimaris Cruz Rodriguez, PSYD
1025 Veterans Memorial Hwy Se Ste 660,
Mableton, GA 30126-7711
Ph: (470) 568-3611 | Stella Dimaris Cruz Rodriguez, PSYD
1025 Veterans Memorial Hwy Se Ste 660,
Mableton, GA 30126-7711
Ph: (470) 568-3611 |
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