Jennifer Alexandria Clark

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

086522 Issued in CA

Practice address

99 Montecillo Rd
San Rafael, CA 94903-3308

Phone

(925) 229-7693

NPI assigned

Feb 24, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia and Analgesia Medical Group Inc 73 clinicians

Permanente Medical Group Inc 10,928 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaiser Foundation Hospital-Santa Rosa Hospital, Santa Rosa, CA, CCN 050690

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Anesthesia & Analgesia Medical Group, Inc.

  • Anesthesiology Physician
  • Santa Rosa, CA
  • NPI 1659320984

  CA

  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  CA

  Medicare reassignment Care Compare group NPD
• Permanente Medical Group, Inc.

  • Clinical Medical Laboratory
  • Berkeley, CA
  • NPI 1083777163
  Care Compare group
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Redwood City, CA
  • NPI 1639252604
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

• Kaiser Foundation Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1407925928

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1023315231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BARNESON AVE",
            "address_2": "#C",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022978",
            "telephone_number": "310-266-2796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 MONTECILLO RD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033308",
            "telephone_number": "925-229-7693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "middle_name": "ALEXANDRIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-24",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "086522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "99 Montecillo Rd",
            "city": "San Rafael",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949033308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Angela Clare
• Clarity Telehealth of Florida
• Clarity-James Medical Services Corp
• Cynthia Billmeyer Clark, MD
• Eugenia Clark, M.A. ED., BCBA
• Julianna Frances Clark
• Wade Clark, PHARM.D.
• Claudine Katherine Clarke, M. S.
• Nicole Marie Clausen, PHARM.D.
• Kaelen Clayton

• All providers in San Rafael, CA
• Certified Registered Nurse Anesthetist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.