Mrs Lacey Leigh Dietrich, ARNP in Jacksonville, FL

Mrs Lacey Leigh Dietrich, ARNP is a medicare enrolled "Nurse Practitioner" in Jacksonville, Florida. Her current practice location is 1 Shircliff Way, Jacksonville, Florida. You can reach out to her office (for appointments etc.) via phone at (904) 308-5000.

Mrs Lacey Leigh Dietrich is licensed to practice in Florida (license number APRN9316073) 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 1811481294.

Contact Information

	Mrs Lacey Leigh Dietrich, ARNP
	1 Shircliff Way, Jacksonville, FL 32204-4748
	(904) 308-5000
	Not Available

Map and Direction

Provider's Profile

Full Name	Mrs Lacey Leigh Dietrich
Gender	Female
Speciality	Nurse Practitioner
Location	1 Shircliff Way, Jacksonville, Florida
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1811481294
Provider Enumeration Date: 06/19/2018
Last Update Date: 05/31/2023

Medicare PECOS Information:

PECOS PAC ID: 3274887153
Enrollment ID: I20181112002139

Medical Identifiers

Medical identifiers for Mrs Lacey Leigh Dietrich such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1811481294	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	ARNP9316073 (Florida)	Secondary
363L00000X	Nurse Practitioner	APRN9316073 (Florida)	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. Mrs Lacey Leigh Dietrich allows following entities to bill medicare on her behalf.

Entity Name	Emergency Medical Specialists Of Jacksonville
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1295738367 PECOS PAC ID: 2668361080 Enrollment ID: O20040313000203

Entity Name	Paragon Emergency Services Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1912101650 PECOS PAC ID: 8628153087 Enrollment ID: O20080310000143

Entity Name	Emsj Of Northeast Florida Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1720753536 PECOS PAC ID: 0446657209 Enrollment ID: O20210921001385

Entity Name	Cep America Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1295442614 PECOS PAC ID: 6608056171 Enrollment ID: O20230131002198

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. Mrs Lacey Leigh Dietrich 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
Mrs Lacey Leigh Dietrich, ARNP 1842 Sentry Oak Ct, Fleming Island, FL 32003-3764 Ph: (904) 446-6789	Mrs Lacey Leigh Dietrich, ARNP 1 Shircliff Way, Jacksonville, FL 32204-4748 Ph: (904) 308-5000

Reviews and Comments

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Mrs Lacey Leigh Dietrich, ARNP - Medicare Nurse Practitioner in Jacksonville, FL