Individual provider Active NPI

Karen Michelle Clark, CRNA

  • Certified Registered Nurse Anesthetist
  • San Diego, CA
National Provider Identifier
1033301171
Registry record updated Aug 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
NA4079 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103
Phone
(800) 926-8273
NPI assigned
Aug 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 0024167421 VA
Certified Registered Nurse Anesthetist 367500000X NA4079 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Other practice location 1

134 Business Park Dr
Virginia Beach, VA 23462-6523
Phone (757) 473-0044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
73.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4079CAMDOccupational Therapy Assistant
NA4079CAMDCertified Registered Nurse Anesthetist
0024167421VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Nurse Anesthetist, Certified Registered CurrentSince Jul 20, 2019 Accepting new patients
Regents of the University of California CurrentSince Jul 20, 2019 Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

200 W Arbor Dr
#8201
San Diego, CA 92103
Phone (858) 534-6290

6655 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3130

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1033301171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92103",
            "telephone_number": "800-926-8273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "134 Business Park Dr",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234626523",
            "country_code": "US",
            "telephone_number": "757-473-0044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAREN",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-13",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024167421",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "NA4079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.