Dr Lara Diane Church, MD in Ponte Vedra, FL

Dr Lara Diane Church, MD is a medicare enrolled "Family Medicine" physician in Ponte Vedra, Florida. She went to University Of South Florida College Of Medicine and graduated in 2002 and has 22 years of diverse experience with area of expertise as Family Practice. She is a member of the group practice Southcentral Foundation and her current practice location is 141 Hilden Rd Ste 201, Credentialing Department, Ponte Vedra, Florida. You can reach out to her office (for appointments etc.) via phone at (904) 825-1941.

Dr Lara Diane Church is licensed to practice in Florida (license number ME105548) 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 1043280449.

Contact Information

	Dr Lara Diane Church, MD
	141 Hilden Rd Ste 201, Credentialing Department, Ponte Vedra, FL 32081-8400
	(904) 825-1941
	(904) 829-2850

Map and Direction

Physician's Profile

Full Name	Dr Lara Diane Church
Gender	Female
Speciality	Family Practice
Experience	22 Years
Location	141 Hilden Rd Ste 201, Ponte Vedra, Florida
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Dr Lara Diane Church attended and graduated from University Of South Florida College Of Medicine in 2002

NPI Data:

NPI Number: 1043280449
Provider Enumeration Date: 01/26/2006
Last Update Date: 12/27/2018

Medicare PECOS Information:

PECOS PAC ID: 8628236759
Enrollment ID: I20231201002393

Medical Identifiers

Medical identifiers for Dr Lara Diane Church such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1043280449	NPI	-	NPPES
P01431326	Other	FL	RR MEDICARE

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	ME105548 (Florida)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Alaska Native Medical Center	Anchorage, AK	Hospital
Baptist Health Medical Center - Jacksonville	Jacksonville, FL	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Southcentral Foundation	5496663627	112

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 Lara Diane Church allows following entities to bill medicare on her behalf.

Entity Name	Alaska Native Tribal Health Consortium
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1437189339 PECOS PAC ID: 6709780265 Enrollment ID: O20031125000772

Entity Name	Southcentral Foundation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1780614263 PECOS PAC ID: 5496663627 Enrollment ID: O20051027000416

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 Lara Diane Church 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 Lara Diane Church, MD Po Box 45443, Salt Lake City, UT 84145-0443 Ph: (904) 202-1032	Dr Lara Diane Church, MD 141 Hilden Rd Ste 201, Credentialing Department, Ponte Vedra, FL 32081-8400 Ph: (904) 825-1941

Reviews and Comments

Family Medicine Doctors in Ponte Vedra, FL

Nasrin Datar Raina, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 151 Pine Lake Dr Ste B, Ponte Vedra, FL 32081 Phone: 904-543-3677
Richard W. Townsend, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 351 Town Plaza Ave Ste 105a, Ponte Vedra, FL 32081 Phone: 904-819-3233 Fax: 904-456-0819
Elizabeth Anne Nelson Andersen, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 141 Hilden Rd Ste 201, Ponte Vedra, FL 32081 Phone: 904-825-1941 Fax: 904-390-7460
Hiro M Rahbar, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 400 Colonnade Dr, Ponte Vedra, FL 32081 Phone: 904-824-1020 Fax: 904-824-5333
Donald W Tice, D.O. Family Medicine Medicare: Medicare Enrolled Practice Location: 141 Hilden Rd Ste 201, Ponte Vedra, FL 32081 Phone: 904-825-1941 Fax: 904-390-7460
Sarah Crane Adams, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 400 Colonnade Dr Ste 160, Ponte Vedra, FL 32081 Phone: 904-824-1020 Fax: 904-390-7503

Dr Lara Diane Church, MD - Medicare Family Practice in Ponte Vedra, FL