Jennifer Ann Clark

Primary specialty

AudiologistTaxonomy code 231H00000X

License

AUD-1728 Issued in ID

Practice address

330 Warner Dr
Lewiston, ID 83501-4441

Phone

(208) 746-0193

Fax

(208) 746-7074

NPI assigned

Apr 9, 2008

Last updated

Apr 28, 2010By 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 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Valley Facial Plastics & ENT, PA

  • Otolaryngology Physician
  • Lewiston, ID
  • NPI 1952441024
  NPD (past)

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272412800000",
    "number": "1053584292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 WARNER DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014441",
            "telephone_number": "208-746-0193",
            "fax_number": "208-746-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 WARNER DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014441",
            "telephone_number": "208-746-0193",
            "fax_number": "208-746-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-09",
        "last_updated": "2010-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "ID",
            "license": "AUD-1728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD OF ID",
            "identifier": "000010170154",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "1580017",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ID",
            "identifier": "AU022",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00678807",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808195700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8560278",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Bowman, Pmhnp-BC, PLLC
• Anna Maria Christopher, B PHARM
• City of Lewiston
• Brandon W. Clark, LCSW
• Diane Clark, RN, BSN
• Clearview Surgery Center, LLC
• Clearwater Counseling
• Clearwater Gastroenterology
• Clearwater Medical Center PLLC (Clearwater Medical Clinic)
• Clearwater Neurosciences PLLC

• Audiologist in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Audiologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.