Dr Jack Diep, MD is a medicare enrolled "Pain Medicine - Interventional Pain Medicine" physician in Lake Havasu City, Arizona. He graduated from medical school in 2013 and has 11 years of diverse experience with area of expertise as Pain Management. He is a member of the group practice Lakeside Orthopedic Institute Llc, Lakeside Orthopedic Institute Llc and his current practice location is
1791 Mesquite Ave, Lake Havasu City, Arizona. You can reach out to his office (for appointments etc.) via phone at
(928) 505-5555.
Dr Jack Diep is licensed to practice in Arizona (license number 55528) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1912333014.
Physician's Profile
| Full Name | Dr Jack Diep |
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| Gender | Male |
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| Speciality | Pain Management |
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| Experience | 11 Years |
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| Location | 1791 Mesquite Ave, Lake Havasu City, Arizona |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Jack Diep graduated from medical school in 2013
NPI Data:
- NPI Number: 1912333014
- Provider Enumeration Date: 09/20/2013
- Last Update Date: 09/27/2022
Medicare PECOS Information:
- PECOS PAC ID: 6800142753
- Enrollment ID: I20180706000866
Medical Identifiers
Medical identifiers for Dr Jack Diep such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1912333014 | NPI | - | NPPES |
| 369607 | Medicaid | AZ | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207LP2900X | Anesthesiology - Pain Medicine | 55528 (Arizona) | Secondary |
| 208VP0000X | Pain Medicine - Pain Medicine | 55528 (Arizona) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | 55528 (Arizona) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Lakeside Orthopedic Institute Llc | 1052316445 | 18 |
| Lakeside Orthopedic Institute Llc | 1052316445 | 18 |
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. Dr Jack Diep allows following entities to bill medicare on his behalf.
| Entity Name | Lakeside Orthopedic Institute Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1275564916
PECOS PAC ID: 1052316445
Enrollment ID: O20060918000307 |
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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. Dr Jack Diep 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 |
|---|
Dr Jack Diep, MD
25 Riviera Blvd,
Lake Havasu City, AZ 86403-5694
Ph: (928) 505-5555 | Dr Jack Diep, MD
1791 Mesquite Ave,
Lake Havasu City, AZ 86403-5648
Ph: (928) 505-5555 |
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