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 10 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice 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 | 10 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 |
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| Bellin Memorial Hospital Inc | 8820900749 | 536 |
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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