Individual provider Active NPI

Lauren Clark

  • Nurse Practitioner
  • Macon, GA
National Provider Identifier
1043776891
Registry record updated Feb 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN205830 Issued in GA
Practice address
3708 Northside Dr
Macon, GA 31210-2404
Phone
(478) 745-4206
NPI assigned
Feb 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN205830 GA Primary

Addresses

Primary practice location

3708 Northside Dr
Macon, GA 31210-2404

Mailing address

3708 Northside Dr
Macon, GA 31210-2404

Other identifiers 1

IdentifierTypeStateIssuer
300022345AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20230411000524 GA Practitioner - Nurse Practitioner 1557736295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meadows Multispecialty Associates LLCGroup PAC ID 6002223484, 28 clinicians

Practice addresses (Care Compare)

104 Fairview Park Dr
Dublin, GA 31021-2565
Phone (478) 277-1255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
76.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN205830GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Meadows Multispecialty Associates, LLC CurrentSince May 29, 2023 Accepting new patients

Locations

104 Fairview Park Dr
Dublin, GA 31021
Phone (478) 272-1366

1707 Meadows Ln
Ste A
Vidalia, GA 30474
Phone (912) 538-0003

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1550448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1043776891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3708 NORTHSIDE DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3708 NORTHSIDE DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102404",
            "telephone_number": "478-745-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LAUREN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-18",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN205830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300022345A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.