Individual provider Active NPI

Jacey Ane Lepage, M.D.

  • Trauma Surgery Physician
  • Detroit, MI
National Provider Identifier
1790166494
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
01086554A Issued in IN
Practice address
22101 Moross Rd
Detroit, MI 48236-2148
Phone
(313) 343-4000
NPI assigned
Jun 18, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X 01086554A IN Primary
Student in an Organized Health Care Education/Training Program 390200000X 4301107377 MI

Addresses

Primary practice location

22101 Moross Rd
Detroit, MI 48236-2148

Mailing address

22101 Moross Rd
Detroit, MI 48236-2148

Other names 1

  • Jacey Ane Loberg Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211102000426 IN Practitioner - General SurgeryPractitioner - Other (Physician) 1254622541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Colorado School of Medicine, Aurora, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lutheran Medical Group LLCGroup PAC ID 4981751617, 251 clinicians

Practice addresses (Care Compare)

7900 W Jefferson Blvd
Suite 306
Fort Wayne, IN 46804-4128
Phone (260) 458-3610

Hospital & facility affiliations

  • Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017

Merit-based Incentive Payment System (MIPS)

Final score
90.99 of 100Reported as apm
Quality
77.41
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lutheran Medical Group LLC CurrentSince Oct 26, 2021 Accepting new patients
Lutheran Medical Group LLC CurrentSince Oct 26, 2021 Accepting new patients
Iom Health System LP Past Accepting new patients

Locations

7910 W Jefferson Blvd
Ste 112
Fort Wayne, IN 46804
Phone (260) 969-7121

3534 Brooklyn Ave
Fort Wayne, IN 46809
Phone (219) 478-5180

2516 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 434-6076

7900 W Jefferson Blvd
Ste 306
Fort Wayne, IN 46804
Phone (260) 458-3610

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1790166494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEPAGE",
        "first_name": "JACEY",
        "middle_name": "ANE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-18",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "IN",
            "license": "01086554A",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301107377",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACEY",
            "last_name": "LOBERG",
            "middle_name": "ANE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.