JERICE LAKE
NPI 1154878072
Nurse Practitioner - Pediatrics in Mesa, AZ
About Jerice Lake NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JERICE LAKE (NPI 1154878072) is an individual pediatrics provider in Mesa, Arizona, licensed in Arizona (264646) and active in the NPI registry since September 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jerice Lake is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jerice Lake reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Seattle, WA 98118
- Reassigned Medicare billing, Washington enrollment
- Medicare enrollment name: Seattle Childrens Hospital
- 912 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 85201 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MESA, AZ 85201
MESA, AZ 85201
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jerice Lake's NPI number?
The NPI number for Jerice Lake is 1154878072. It was assigned to this individual provider in the NPPES registry on September 8, 2016.
Where is Jerice Lake located?
Jerice Lake practices at 2343 W Main St Apt. 2030, Mesa, AZ 85201. The listed phone number is (340) 642-4597.
What is Jerice Lake's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.
Is Jerice Lake enrolled in Medicare?
Yes. Jerice Lake is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jerice Lake's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jerice Lake reassigns Medicare benefits to Seattle Children's Hospital (Seattle, WA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jerice Lake's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jerice Lake was last updated on February 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jerice Lake · NPI 1154878072
Pediatrics physician in Mesa, Arizona. Individual provider, active in the CMS NPPES registry since September 8, 2016.
## Identity
- **NPI:** 1154878072 (Entity type: Individual)
- **Enumerated:** September 8, 2016
- **Primary specialty:** Nurse Practitioner - Pediatrics · taxonomy 363LP0200X
- **State license:** 264646 (Arizona)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 2343 W MAIN ST, APT. 2030, Mesa, AZ 85201-9003
- **Phone:** (340) 642-4597
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Seattle Children's Hospital (NPI 1134251747, Seattle, WA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** February 28, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1154878072) · Data from the CMS NPPES public registry.