Susan Heather Lake, AGNP - Medicare Nurse Practitioner in Trenton, NJ

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Susan Heather Lake, AGNP is a medicare enrolled "Nurse Practitioner - Gerontology" in Trenton, New Jersey. Her current practice location is 1618 Riverside Drive, Trenton, New Jersey. You can reach out to her office (for appointments etc.) via phone at (609) 372-7754.

Susan Heather Lake is licensed to practice in New Jersey (license number 26NJ00877500) 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 1790255941.

Contact Information

Susan Heather Lake, AGNP
1618 Riverside Drive,
Trenton, NJ 08618
(609) 372-7754
Not Available

Map and Direction




Provider's Profile

Full NameSusan Heather Lake
GenderFemale
SpecialityNurse Practitioner - Gerontology
Location1618 Riverside Drive, Trenton, New Jersey
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1790255941
  • Provider Enumeration Date: 11/30/2018
  • Last Update Date: 11/30/2018
  Medicare PECOS Information:
  • PECOS PAC ID: 4082953294
  • Enrollment ID: I20190306001848

Medical Identifiers

Medical identifiers for Susan Heather Lake such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1790255941NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LA2200XNurse Practitioner - Adult Health 26NJ00877500 (New Jersey)Secondary
363LG0600XNurse Practitioner - Gerontology 26NJ00877500 (New Jersey)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. Susan Heather Lake allows following entities to bill medicare on her behalf.
Entity NamePractitioner Support Services Llp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1114115706
PECOS PAC ID: 3375596984
Enrollment ID: O20170510000579
Entity NameLongevity Clinical Ltc Associates Of New Jersey
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1376114322
PECOS PAC ID: 8820496540
Enrollment ID: O20211012000002

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. Susan Heather 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 AddressPractice Location Address
Susan Heather Lake, AGNP
1618 Riverside Drive,
Trenton, NJ 08618

Ph: (609) 372-7754		Susan Heather Lake, AGNP
1618 Riverside Drive,
Trenton, NJ 08618

Ph: (609) 372-7754

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.