Lacey L Jandrin, PA-C is a medicare enrolled "Physician Assistant" provider in Green Bay, Wisconsin. She went to University Of North Dakota School Of Medicine and graduated in 2016 and has 8 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Oconto Hospital And Medical Center Inc, Bellin Memorial Hospital Inc and her current practice location is
1970 S Ridge Rd, Green Bay, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(920) 430-4888.
Lacey L Jandrin is licensed to practice in Wisconsin (license number 3761-23) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1104183516.
Healthcare Provider's Profile
| Full Name | Lacey L Jandrin |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Experience | 8 Years |
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| Location | 1970 S Ridge Rd, Green Bay, Wisconsin |
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| Accepts Medicare Assignments | Yes. She 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:
- Lacey L Jandrin attended and graduated from University Of North Dakota School Of Medicine in 2016
NPI Data:
- NPI Number: 1104183516
- Provider Enumeration Date: 04/23/2012
- Last Update Date: 01/30/2023
Medicare PECOS Information:
- PECOS PAC ID: 8820380132
- Enrollment ID: I20160707000393
Medical Identifiers
Medical identifiers for Lacey L Jandrin such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1104183516 | NPI | - | NPPES |
| 1135070 | Other | | NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225X00000X | Occupational Therapist | 4712 (Wisconsin) | Secondary |
| 363A00000X | Physician Assistant | 1135070 (Wisconsin) | Secondary |
| 363A00000X | Physician Assistant | 3761-23 (Wisconsin) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Oconto Hospital And Medical Center Inc | 2163461781 | 193 |
| Bellin Memorial Hospital Inc | 8820900749 | 533 |
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. Lacey L Jandrin 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 |
|---|
Lacey L Jandrin, PA-C
Po Box 22487,
Green Bay, WI 54305-2487
Ph: (920) 445-7210 | Lacey L Jandrin, PA-C
1970 S Ridge Rd,
Green Bay, WI 54304-4125
Ph: (920) 430-4888 |
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