Dr John Walter Lace, PHD in Holmen, WI - Medicare Clinical Psychologist Provider

Dr John Walter Lace, PHD is a medicare enrolled "Psychologist - Clinical" provider in Holmen, Wisconsin. He graduated from medical school in 2020 and has 6 years of diverse experience with area of expertise as Clinical Psychologist. He is a member of the group practice St Lukes Methodist Hospital and his current practice location is 1303 Main Street S, Holmen, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (608) 785-0940.

Dr John Walter Lace is licensed to practice in Wisconsin (license number 5000-57) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1528705050.

Contact Information

	Dr John Walter Lace, PHD
	1303 Main Street S, Holmen, WI 54636-8927
	(608) 785-0940
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Dr John Walter Lace
Gender	Male
Speciality	Clinical Psychologist
Experience	6 Years
Location	1303 Main Street S, Holmen, Wisconsin
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Dr John Walter Lace graduated from medical school in 2020

NPI Data:

NPI Number: 1528705050
Provider Enumeration Date: 05/17/2022
Last Update Date: 12/23/2025

Medicare PECOS Information:

PECOS PAC ID: 7416332218
Enrollment ID: I20241002003016

Medical Identifiers

Medical identifiers for Dr John Walter Lace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1528705050	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	5000-57 (Wisconsin)	Secondary
103G00000X	Clinical Neuropsychologist	110965 (Iowa)	Secondary
103G00000X	Clinical Neuropsychologist	5000-57 (Wisconsin)	Secondary
103TH0100X	Psychologist - Health Service	126559 (Iowa)	Secondary
103TC0700X	Psychologist - Clinical	5000-57 (Wisconsin)	Primary
103T00000X	Psychologist	110965 (Iowa)	Secondary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
St Lukes Hospital	Cedar rapids, IA	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
St Lukes Methodist Hospital	6608786751	70

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 John Walter Lace allows following entities to bill medicare on his behalf.

Entity Name	St Lukes Methodist Hospital
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1073553939 PECOS PAC ID: 6608786751 Enrollment ID: O20040204000942

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 John Walter Lace 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 John Walter Lace, PHD P O Box 860912, Minneapolis, MN 55486-0912 Ph: (507) 284-2511	Dr John Walter Lace, PHD 1303 Main Street S, Holmen, WI 54636-8927 Ph: (608) 785-0940

Dr John Walter Lace, PHD - Medicare Psychologist in Holmen, WI