Whitney Nicole Clark, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

APRN.CNM.019373 Issued in OH

Practice address

1140 S Knoxville Ave Ste B
Saint Marys, OH 45885-2609

Phone

(419) 394-7314

Fax

(419) 394-7313

NPI assigned

Jul 9, 2018

Last updated

Jul 28, 2023By the provider in NPPES

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

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Certified Nurse Midwife (CNM)

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

JTDM Family Practice LLCGroup PAC ID 2163415837, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grand Lake Health System Hospital, Saint Marys, OH, CCN 360032

Merit-based Incentive Payment System (MIPS)

Final score

85.44 of 100Reported as group

Quality

78

Promoting interoperability

96

Improvement activities

40

Cost

76.79

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• JTDM Family Practice LLC

  • Family Medicine Physician
  • Saint Marys, OH
  • NPI 1184652539

  Advanced Practice Midwife

  Medicare reassignment Care Compare group NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment NPD
• Joint Township District Memorial Hospital

  • General Acute Care Hospital
  • Saint Marys, OH
  • NPI 1639133002
  NPD (past)
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

• Joint Township District Memorial Hospital

  • General Acute Care Hospital
  • Saint Marys, OH
  • NPI 1639133002
  Care Compare affiliation

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1033605431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 S KNOXVILLE AVE STE D",
            "city": "SAINT MARYS",
            "state": "OH",
            "postal_code": "458852609",
            "telephone_number": "419-300-1129",
            "fax_number": "419-394-9575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 S KNOXVILLE AVE STE B",
            "city": "SAINT MARYS",
            "state": "OH",
            "postal_code": "458852609",
            "telephone_number": "419-394-7314",
            "fax_number": "419-394-7313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Pro Dr Ste D3",
            "address_purpose": "LOCATION",
            "city": "Celina",
            "state": "OH",
            "postal_code": "458223307",
            "country_code": "US",
            "telephone_number": "419-394-7314",
            "fax_number": "419-394-7313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WHITNEY",
        "middle_name": "NICOLE",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OH",
            "license": "APRN.CNM.019373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0300634",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "whitneyclark@glhs.allscriptsdirect.net",
            "affiliation": "Y",
            "affiliationName": "JTDM Family Practice LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1140 S Knoxville Ave Ste B",
            "city": "Saint Marys",
            "state": "OH",
            "country_code": "US",
            "postal_code": "458852609",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "whitneyclark@glhs.allscriptsdirect.net",
            "affiliation": "Y",
            "affiliationName": "JTDM Family Practice LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "801 Pro Dr Ste D3",
            "city": "Celina",
            "state": "OH",
            "country_code": "US",
            "postal_code": "458223307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chalasani MD Inc. (St. Marys Family Practice)
• Padmaja Chalasani, M.D.
• Jeffrey S. Chivington, D.C.
• Kyle Christman, PHARMD
• City of St Marys
• Cole Vision Corporation
• Michael Compton, D.C.
• Margene Rose Craft
• Ronald Craft
• Fred A Culver, MT

• Advanced Practice Midwife in Saint Marys, OH
• Providers in Saint Marys, OH by specialty
• Advanced Practice Midwife in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.

Verify at the official NPI Registry.