Common Contracts
1 similar Medicare Private Contract contracts
MEDICARE PRIVATE CONTRACTMedicare Private Contract • February 29th, 2016
This agreement is between Dr. Samuel Levine whose office is located at 166 Bunn Drive, Princeton, NJ 08540, and patient (indicated above) who is a Medicare Part B beneficiary seeking services covered under Medicare Part B. I have informed my patient that I have opted out of the Medicare Program effective November 1, 2015.
