Ms Theresa Bergen Wade, APRN is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Captain Cook, Hawaii. Her current practice location is
83-5737 Kanele St, Captain Cook, Hawaii. You can reach out to her office (for appointments etc.) via phone at
(808) 333-5977.
Ms Theresa Bergen Wade is licensed to practice in Hawaii (license number APRN - 1950) 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 1063497758.
Provider's Profile
| Full Name | Ms Theresa Bergen Wade |
|---|
| Gender | Female |
|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
|---|
| Location | 83-5737 Kanele St, Captain Cook, Hawaii |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1063497758
- Provider Enumeration Date: 12/14/2005
- Last Update Date: 01/23/2019
Medicare PECOS Information:
- PECOS PAC ID: 7012215643
- Enrollment ID: I20160415000924
Medical Identifiers
Medical identifiers for Ms Theresa Bergen Wade such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1063497758 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 7512 (California) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | APRN - 1950 (Hawaii) | Primary |
| 363L00000X | Nurse Practitioner | 7512 (California) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 509869 (California) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 7512 (California) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | APRN - 1950 (Hawaii) | Secondary |
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. Ms Theresa Bergen Wade allows following entities to bill medicare on her behalf.
| Entity Name | Care Hawaii, Inc. |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1770603425
PECOS PAC ID: 4789726415
Enrollment ID: O20100119000582 |
|---|
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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. Ms Theresa Bergen Wade 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 |
|---|
Ms Theresa Bergen Wade, APRN
83-5737 Kanele St,
Captain Cook, HI 96704-8329
Ph: (808) 333-5977 | Ms Theresa Bergen Wade, APRN
83-5737 Kanele St,
Captain Cook, HI 96704
Ph: (808) 333-5977 |
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