Common Contracts
1 similar Medicare Private Contract contracts
MEDICARE PRIVATE CONTRACTMedicare Private Contract • November 1st, 2017
THIS CONTRACTUAL AGREEMENT IS BETWEEN DR. SHARAD PANDHI, D.D.S. (“DENTIST”) WHOSE PRINCIPAL PLACE OF BUSINESS IS AT 5828 N ORACLE RD SUITE #100, TUCSON, AZ 85704 AND (“PATIENT”). A MEDICARE PART B BENEFICIARY. AS A DENTIST THAT HAS OPTED OUT OF THE MEDICARE PROGRAM ON 07/01/2004 FOR A PERIOD OF AT LEAST 2 YEARS, DR. SHARAD PANDHI HAS INFORMED PATIENT THAT HE/SHE PROIDES TO ANY MEDICARE BENEFIIARY IS NOT SUBJECT TO MEDICARE LIMITS PERSUANT TO DENTIST “OPT OUT”AGREEMENT WITH MEDIACRE PATIENT HAS ALSO BEEN INFORMED THAT DENTIST IS PROHIBITED FROM BILLING MEDICARE FOR SERVICES PROVIDED TO PATIENT.
