Shea Randi Clark

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

138248 Issued in NC

Practice address

1000 Blythe Blvd
Charlotte, NC 28203-5812

Phone

(704) 355-2000

NPI assigned

Jul 13, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CHS Anesthesia Services Group IncGroup PAC ID 5799007324, 742 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stanly Regional Medical Center Hospital, Albemarle, NC, CCN 340119

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.

• CHS Anesthesia Services Group Inc

  • Anesthesiology Physician
  • Charlotte, NC
  • NPI 1346649415
  Medicare reassignment Care Compare group NPD

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

• Atrium Health Hospitals Inc

  • General Acute Care Hospital
  • Albemarle, NC
  • NPI 1104627926
  Care Compare affiliation
• Atrium Health Hospitals Inc

  • Psychiatric Hospital Unit
  • Albemarle, NC
  • NPI 1740081553
  Care Compare affiliation

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

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1043882764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 VALLEYVIEW DR",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280019592",
            "telephone_number": "704-438-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHEA",
        "middle_name": "RANDI",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "138248",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "270821",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Clark
• Peter Earl Clark, MD
• Robert Brandon Clark, FNP
• Ronald Sevier Clark, CRNA
• Sharon L Clark, MSW, LCSW
• Stephanie Prevatte Clark, LCSW
• Sueanne Clark, NP
• Summer Clark, PHARMD
• Talaya Blakey Clark, MD
• Terri L Clark

• Certified Registered Nurse Anesthetist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Certified Registered Nurse Anesthetist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.