LUCY BOLERJACK DO
NPI 1346815875
Obstetrics & Gynecology in Jacksonville, FL

Q: What is Lucy Bolerjack's NPI number?

The NPI number for Lucy Bolerjack is 1346815875. It was assigned to this individual provider in the NPPES registry on May 26, 2021.

Q: What is Lucy Bolerjack's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Q: When was this NPI record last updated?

The NPPES record for Lucy Bolerjack was last updated on July 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.

Active since May 26, 2021PECOS EnrolledAccepts Medicare Assignment

836 PRUDENTIAL DR STE 1202, JACKSONVILLE, FL 32207(904) 493-5323(866) 554-1605 Get Directions Write a Review

NPPES record last updated: July 11, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 11, 2025, May 26, 2021 (2 updates tracked since 2021).

On this page

About Lucy Bolerjack Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LUCY BOLERJACK DO (NPI 1346815875) is an individual obstetrics & gynecology provider in Jacksonville, Florida, licensed in Florida (OS22431) and active in the NPI registry since May 2021. She is enrolled in Medicare PECOS, is affiliated with Baptist Medical Center Beaches, and maintains a secondary practice location in Grand Blanc.

NPPES Registry Identity

NPI1346815875

Entity TypeIndividualFemale

Primary Taxonomy207V00000X

Provider Legal NameLUCY BOLERJACKCredential: DO

Location Address836 PRUDENTIAL DR STE 1202Jacksonville, FL 32207-8339

Mailing AddressPo Box 748817Atlanta, GA 30374-8817 · (813) 286-0033 · Fax (813) 282-1806

Phone(904) 493-5323

Fax(866) 554-1605

Sole ProprietorNo

Medical School CMSMichigan State University College Of Human MedicineGraduated 2021

Enumeration DateMay 26, 2021

Last NPPES UpdateJuly 11, 20252 updates tracked since enumeration

NPPES CertifiedJuly 11, 2025

✔ NPI 1346815875 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians

Taxonomy Code207V00000X

Licenses✔ Licensed in FL · OS22431✔ Licensed in MI · 5151014839

Definition

An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

836 PRUDENTIAL DR STE 1202, Jacksonville, FL 32207

Open in Google Maps ↗

Secondary Practice Location 1

Location 11 Genesys PkwyGrand Blanc, MI 48439-8065 · Phone (810) 606-5000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Lucy Bolerjack Do 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.

PECOS PAC ID345641445

PECOS Enrollment IDI20250717002980

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Baptist Medical Center Beaches

Acute Care Hospitals · Jacksonville Beach, FL

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100117

Location1350 13th Ave SJacksonville Beach, FL 32250 · Duval County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32207 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$130.04 typical visit price

range $56.00 – $171.84

Typical copayment $32.51 (range $14.00 – $42.96)

Most-billed visit code 99204

Established Patient

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Leave this field empty

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENDRA SECCOMBE APRN

Nurse Practitioner (Women's Health)