Jacqueline Agusta, MSW, LCSW, LCAS is a medicare enrolled "Social Worker - Clinical" provider in Raleigh, North Carolina. Her current practice location is
3012 Falstaff Rd, Raleigh, North Carolina. You can reach out to her office (for appointments etc.) via phone at
(919) 740-8601.
Jacqueline Agusta is licensed to practice in North Carolina (license number C014155) 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 1073170726.
Healthcare Provider's Profile
| Full Name | Jacqueline Agusta |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 3012 Falstaff Rd, Raleigh, North Carolina |
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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: 1073170726
- Provider Enumeration Date: 05/28/2019
- Last Update Date: 12/20/2022
Medicare PECOS Information:
- PECOS PAC ID: 0840663076
- Enrollment ID: I20230308002317
Medical Identifiers
Medical identifiers for Jacqueline Agusta such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1073170726 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LCAS-25813 (North Carolina) | Secondary |
| 1041C0700X | Social Worker - Clinical | C014155 (North Carolina) | 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. Jacqueline Agusta allows following entities to bill medicare on her behalf.
| Entity Name | Southlight Healthcare |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1932300019
PECOS PAC ID: 6901947613
Enrollment ID: O20100104000134 |
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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. Jacqueline Agusta 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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Jacqueline Agusta, MSW, LCSW, LCAS
127 S Atley Ln,
Cary, NC 27513-4136
Ph: () - | Jacqueline Agusta, MSW, LCSW, LCAS
3012 Falstaff Rd,
Raleigh, NC 27610-1813
Ph: (919) 740-8601 |
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