Dr Jerry Edward Douglas, MD in Clearlake, CA

Dr Jerry Edward Douglas, MD is a medicare enrolled "Family Medicine" physician in Clearlake, California. His current practice location is 15322 Lakeshore Dr, Suite 202, Clearlake, California. You can reach out to his office (for appointments etc.) via phone at (707) 994-0303.

Dr Jerry Edward Douglas is licensed to practice in California (license number 53653) 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 1285603621.

Contact Information

	Dr Jerry Edward Douglas, MD
	15322 Lakeshore Dr, Suite 202, Clearlake, CA 95422-9814
	(707) 994-0303
	(707) 995-9447

Map and Direction

Physician's Profile

Full Name	Dr Jerry Edward Douglas
Gender	Male
Speciality	Family Medicine
Location	15322 Lakeshore Dr, Clearlake, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1285603621
Provider Enumeration Date: 03/17/2006
Last Update Date: 04/02/2018

Medicare PECOS Information:

PECOS PAC ID: 6608944616
Enrollment ID: I20090713000422

Medical Identifiers

Medical identifiers for Dr Jerry Edward Douglas such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1285603621	NPI	-	NPPES
200100490	Medicaid	IN
000000190581	Other	IN	ANTHEM PROVIDER NUMBER
162528	Other	IN	PHCS PID NUMBER
11484440	Other	IN	CAQH NUMBER

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	01032101A (Indiana)	Secondary
207Q00000X	Family Medicine	C53653 (California)	Secondary
207Q00000X	Family Medicine	53653 (California)	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. Dr Jerry Edward Douglas allows following entities to bill medicare on his behalf.

Entity Name	Adventist Health St. Helena Ob/gyn
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1932176146 PECOS PAC ID: 9234038209 Enrollment ID: O20040108000320

Entity Name	Mendocino Community Health Clinic Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1497961106 PECOS PAC ID: 6305755455 Enrollment ID: O20040826001483

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. Dr Jerry Edward Douglas 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
Dr Jerry Edward Douglas, MD 333 Laws Ave, Ukiah, CA 95482-6540 Ph: (707) 472-3944	Dr Jerry Edward Douglas, MD 15322 Lakeshore Dr, Suite 202, Clearlake, CA 95422-9814 Ph: (707) 994-0303

Reviews and Comments

Family Medicine Doctors in Clearlake, CA

Gail Marquette, FNP Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 15230 Lakeshore Dr, Clearlake, CA 95422 Phone: 707-995-4500 Fax: 707-994-2401
Sonja Derose, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 15230 Lakeshore Dr, Clearlake, CA 95422 Phone: 707-995-4500
Wolfgang Schug, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 15230 Lakeshore Dr, Clearlake, CA 95422 Phone: 707-995-4500 Fax: 707-994-2401
Siqi Ma, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 15230 Lakeshore Dr, Clearlake, CA 95422 Phone: 707-995-4500
Dr. Mark J Freeman, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 15322 Lakeshore Dr, Ste 101, Clearlake, CA 95422 Phone: 707-995-1362 Fax: 707-995-7057
Dr. John Alden Weeks, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 15230 Lakeshore Dr, Suite 101, Clearlake, CA 95422 Phone: 707-994-7377 Fax: 707-994-9456

Dr Jerry Edward Douglas, MD - Medicare Family Medicine in Clearlake, CA