Stacy Lea Clark Bergeron Carter, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN11011922 Issued in FL

Practice address

3501 Johnson St
Hollywood, FL 33021-5421

Phone

(954) 265-7750

Fax

(954) 276-0280

NPI assigned

Mar 19, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Regional Hospital Hospital, Hollywood, FL, CCN 100038
• Memorial Hospital West Hospital, Pembroke Pines, FL, CCN 100281

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sclarkbergeron281487@mhsdirect.net

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.

• South Broward Hospital District

  • Advanced Heart Failure and Transplant Cardiology Physician
  • Hollywood, FL
  • NPI 1962991562
  Medicare reassignment Care Compare group NPD
• South Broward Hospital District

  • Home Infusion Therapy Pharmacy
  • Miramar, FL
  • NPI 1043656614
  NPD
• South Broward Hospital District

  • Pediatric Orthopaedic Surgery Physician
  • Hollywood, FL
  • NPI 1407865520
  NPD (past)

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

• South Broward Hospital District

  • General Acute Care Hospital
  • Pembroke Pines, FL
  • NPI 1134102080
  Care Compare affiliation
• South Broward Hospital District

  • General Acute Care Hospital
  • Hollywood, FL
  • NPI 1780667923
  Care Compare affiliation

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1033795232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 JOHNSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215421",
            "telephone_number": "954-265-7750",
            "fax_number": "954-276-0280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "603 N Flamingo Rd Ste 255",
            "address_purpose": "LOCATION",
            "city": "Pembroke Pines",
            "state": "FL",
            "postal_code": "330281013",
            "country_code": "US",
            "telephone_number": "954-265-7750",
            "fax_number": "954-276-0280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK BERGERON CARTER",
        "first_name": "STACY",
        "middle_name": "LEA",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-19",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11011922",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11011922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113475400",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sclarkbergeron281487@MHSDIRECT.NET",
            "affiliation": "N",
            "address_1": "3501 Johnson St",
            "city": "Hollywood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330215421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• City of Hollywood
• City of Miramar
• Citywide Home Health Care LLC
• Michelle Cius, APRN
• Clara Peicher de Fleischer PA
• Gabrielle Marie Clark, MS
• Kevin Dewitt Clark, AP
• Rita Clark, LCSW
• Kena Anthony Clarke, ORTHOPAEDIC TECH
• Lamont Clarke

• Nurse Practitioner in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.