Jerice Lake, in Mesa, AZ - Medicare Nurse Practitioner

Jerice Lake, is a medicare enrolled "Nurse Practitioner - Pediatrics" in Mesa, Arizona. Her current practice location is 2343 W Main St, Apt. 2030, Mesa, Arizona. You can reach out to her office (for appointments etc.) via phone at (340) 642-4597.

Jerice Lake is licensed to practice in Arizona (license number 264646) 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 1154878072.

Contact Information

	Jerice Lake,
	2343 W Main St, Apt. 2030, Mesa, AZ 85201-9003
	(340) 642-4597
	Not Available

Map and Direction

Provider's Profile

Full Name	Jerice Lake
Gender	Female
Speciality	Nurse Practitioner - Pediatrics
Location	2343 W Main St, Mesa, Arizona
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1154878072
Provider Enumeration Date: 09/08/2016
Last Update Date: 02/28/2022

Medicare PECOS Information:

PECOS PAC ID: 1052707320
Enrollment ID: I20220413002729

Medical Identifiers

Medical identifiers for Jerice Lake such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1154878072	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163W00000X	Registered Nurse	RN198973 (Arizona)	Secondary
363LP0200X	Nurse Practitioner - Pediatrics	264646 (Arizona)	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. Jerice Lake allows following entities to bill medicare on her behalf.

Entity Name	Seattle Children's Hospital
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1003319500 PECOS PAC ID: 9032021050 Enrollment ID: O20031211000532

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. Jerice Lake 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
Jerice Lake, 400 N Coronado St Apt 3010, Chandler, AZ 85224-3207 Ph: () -	Jerice Lake, 2343 W Main St, Apt. 2030, Mesa, AZ 85201-9003 Ph: (340) 642-4597

Reviews and Comments

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Jerice Lake, - Medicare Nurse Practitioner in Mesa, AZ