Jaclyn A Davis, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Fort Lupton, Colorado. Her current practice location is
145 1st St, Fort Lupton, Colorado. You can reach out to her office (for appointments etc.) via phone at
(303) 857-6365.
Jaclyn A Davis is licensed to practice in Colorado (license number 1654) 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 1750682621.
Healthcare Provider's Profile
| Full Name | Jaclyn A Davis |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 145 1st St, Fort Lupton, Colorado |
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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: 1750682621
- Provider Enumeration Date: 11/09/2010
- Last Update Date: 11/09/2010
Medicare PECOS Information:
- PECOS PAC ID: 1254512908
- Enrollment ID: I20131218001314
Medical Identifiers
Medical identifiers for Jaclyn A Davis such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1750682621 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 7241 (Colorado) | Secondary |
| 1041C0700X | Social Worker - Clinical | 1654 (Colorado) | 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. Jaclyn A Davis allows following entities to bill medicare on her behalf.
| Entity Name | Staywell Health Care Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1154342335
PECOS PAC ID: 6305750480
Enrollment ID: O20031113000374 |
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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. Jaclyn A Davis 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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Jaclyn A Davis, LCSW
145 1st St,
Fort Lupton, CO 80621-2002
Ph: (303) 857-6365 | Jaclyn A Davis, LCSW
145 1st St,
Fort Lupton, CO 80621-2002
Ph: (303) 857-6365 |
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