Jessica Clark, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

59466 County Road 113
Elkhart, IN 46517-3644

Phone

(574) 830-5778

NPI assigned

Aug 12, 2022

Last updated

Mar 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Mental Health Counselor

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heart City Health Center IncGroup PAC ID 9931008380, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11397/brand/1/csg/1/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.

• Healthlinc, Inc

  • Community Health Clinic/Center
  • Elkhart, IN
  • NPI 1720033418
  Medicare reassignment Care Compare group NPD
• Healthlinc, Inc

  • Federally Qualified Health Center (FQHC)
  • Elkhart, IN
  • NPI 1861034688
  NPD
• Healthlinc, Inc

  • Federally Qualified Health Center (FQHC)
  • Elkhart, IN
  • NPI 1295143774
  NPD (past)
• Arbor Circle Corporation

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1174601512

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1660262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1063140465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59466 COUNTY ROAD 113",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465173644",
            "telephone_number": "616-617-6866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59466 COUNTY ROAD 113",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465173644",
            "telephone_number": "574-830-5778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-12",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DO NOT HAVE IDENTIFIERS",
            "identifier": "NONE",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Elkhart
• City Optical Co., Inc. (Dr Tavel Family Eye Care)
• Elizabeth Ciupinski
• Meghan Clairday
• Benjamin Jacob Clark, CRNA
• Theresa Ann Clark, FNP-BC
• Makayla Clawson
• Seth Michael Claxton, CRNA
• David Clayton
• Cleveland C Cleary

• Mental Health Counselor in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.