Active NPI
Jacey Ane Lepage, M.D.
- Trauma Surgery Physician
- Detroit, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Trauma Surgery Physician
- License
- 01086554A
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
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
Enrollment records 1
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
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
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.99 of 100
- Quality
- 77.41
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Medical Group LLC | Current | Accepting new patients | |
| Lutheran Medical Group LLC | Current | 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.
-
- Cardiovascular Disease Physician
- Fort Wayne, IN
- NPI 1164662805
-
- Durable Medical Equipment & Medical Supplies
- Fort Wayne, IN
- NPI 1710275664
-
- General Acute Care Hospital
- Fort Wayne, IN
- NPI 1306897335
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Fort Wayne, IN
- NPI 1306897335
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.