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

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: October 18, 2026.

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

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 Health Medical Center - Jacksonville, 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, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignments

2

Medicare enrollment records show Lucy Bolerjack reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Women's Care Florida LLC
170 mi
Obstetrics & Gynecology
4030 W BOY SCOUT BLVD STE 800
Tampa, FL 33607
  • Reassigned Medicare billing, Florida enrollment
  • Medicare enrollment name: Womens Care Florida LLC
  • 679 clinicians in this Medicare group
NPI 1013902923 (813) 286-0333
Womens' Health Hospitalists, LLC
170 mi
Obstetrics & Gynecology
4030 W BOY SCOUT BLVD STE 800
Tampa, FL 33607
  • Reassigned Medicare billing, Florida enrollment
  • 619 clinicians in this Medicare group
NPI 1205295599 (813) 286-0333

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare 2

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

Baptist Health Medical Center - Jacksonville

Acute Care Hospitals · Jacksonville, FL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number100088
Location800 Prudential DrJacksonville, FL 32207 · Duval County
Emergency services Birthing friendly

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.

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)
836 PRUDENTIAL DR STE 1202
JACKSONVILLE, FL 32207
Duval County (904) 493-5323
DORA ENITH IRIZARRY APRN
Nurse Practitioner (Family)
836 PRUDENTIAL DR STE 1202
JACKSONVILLE, FL 32207
Duval County (904) 208-2550
COLBY WOLK DO
Obstetrics & Gynecology
836 PRUDENTIAL DR STE 1202
JACKSONVILLE, FL 32207
Duval County (904) 493-5323
AMY THOMAS APRN
Nurse Practitioner (Family)
836 PRUDENTIAL DR STE 1202
JACKSONVILLE, FL 32207
Duval County (904) 208-2550
MRS. TRINA WILLIAMS APRN
Nurse Practitioner (Women's Health)
836 PRUDENTIAL DR STE 1202
JACKSONVILLE, FL 32207
Duval County (904) 493-5232
HARSHINI SAHANI DO
Obstetrics & Gynecology
836 PRUDENTIAL DR STE 1202
JACKSONVILLE, FL 32207
Duval County (904) 493-5323
ANGELICA SOLANGE CANIZARES APRN, WHCNP-BC
Nurse Practitioner (Women's Health)
836 PRUDENTIAL DR STE 1202
JACKSONVILLE, FL 32207
Duval County (904) 493-5323
DAWN M MORMAK M.D.
Obstetrics & Gynecology
836 PRUDENTIAL DR STE 1202
JACKSONVILLE, FL 32207
Duval County (904) 493-5323

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 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.

Where is Lucy Bolerjack located?

Lucy Bolerjack practices at 836 Prudential Dr Ste 1202, Jacksonville, FL 32207. The listed phone number is (904) 493-5323.

What is Lucy Bolerjack's specialty?

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

Is Lucy Bolerjack enrolled in Medicare?

Yes. Lucy Bolerjack 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 organizations bill Medicare for Lucy Bolerjack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lucy Bolerjack reassigns Medicare benefits to 2 organizations: Women's Care Florida LLC (Tampa, FL) and Womens' Health Hospitalists, LLC (Tampa, FL). Each 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 Lucy Bolerjack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Lucy Bolerjack accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Ambetter of Alabama, Cigna HealthCare of Florida, Inc. and Cigna Healthcare and 2 other insurers list Lucy Bolerjack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Lucy Bolerjack affiliated with any hospitals?

According to CMS data, Lucy Bolerjack is affiliated with Baptist Health Medical Center - Jacksonville and Baptist Medical Center Beaches.

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 15 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.