Jack Lee Suddreth, CRNA in Petersburg, VA - Medicare Nurse Anesthetist, Certified Registered

Jack Lee Suddreth, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Petersburg, Virginia. His current practice location is 801 S Adams St, Petersburg, Virginia. You can reach out to his office (for appointments etc.) via phone at (804) 862-5000.

Jack Lee Suddreth is licensed to practice in Virginia (license number 0024164859) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1083676274.

Contact Information

	Jack Lee Suddreth, CRNA
	801 S Adams St, Petersburg, VA 23808-2938
	(804) 862-5000
	(804) 862-5948

Map and Direction

Provider's Profile

Full Name	Jack Lee Suddreth
Gender	Male
Speciality	Nurse Anesthetist, Certified Registered
Location	801 S Adams St, Petersburg, Virginia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1083676274
Provider Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007

Medicare PECOS Information:

PECOS PAC ID: 1951338474
Enrollment ID: I20061205000690

Medical Identifiers

Medical identifiers for Jack Lee Suddreth such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1083676274	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	0024164859 (Virginia)	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. Jack Lee Suddreth allows following entities to bill medicare on his behalf.

Entity Name	Memorial Hospital Of Texas County Authority
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1144205360 PECOS PAC ID: 5395647655 Enrollment ID: O20040126000739

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. Jack Lee Suddreth 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
Jack Lee Suddreth, CRNA Po Box 740209, Dept 1041, Atlanta, GA 30374-0209 Ph: (941) 360-1566	Jack Lee Suddreth, CRNA 801 S Adams St, Petersburg, VA 23808-2938 Ph: (804) 862-5000

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Petersburg, VA

Maribel K Abenir, CRNA-NP Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 200 Medical Park Blvd, Southside Regional Medical Center, Petersburg, VA 23805 Phone: 804-765-5000 Fax: 804-765-6250
Ann Wade Sublette, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 801 S Adams St, Petersburg, VA 23803 Phone: 804-862-5000 Fax: 804-862-5948
Edde Karen Springer, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 200 Medical Park Blvd, Petersburg, VA 23805 Phone: 804-765-5060
Irene Mai Ratliff, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 200 Medical Park Blvd, Petersburg, VA 23805 Phone: 804-765-5000
Kendria Sherrill Frasier, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 200 Medical Park Blvd, Petersburg, VA 23805 Phone: 703-295-9360
Heather Day, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 200 Medical Park Blvd, Petersburg, VA 23805 Phone: 804-288-4453 Fax: 804-288-1621

Jack Lee Suddreth, CRNA - Medicare Nurse Anesthetist, Certified Registered in Petersburg, VA