Nicole C. Clark, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02006481A Issued in IN

Practice address

2705 N Lebanon St Ste 300
Lebanon, IN 46052-8622

Phone

(765) 485-8649

Fax

(765) 485-8650

NPI assigned

Apr 5, 2018

Last updated

Oct 10, 2023By 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 1

Other names 1

• Nicole C. Schmitt Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Witham Memorial HospitalGroup PAC ID 4082523170, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Witham Health Services Hospital, Lebanon, IN, CCN 150104
• Indiana University Health Frankfort Inc Hospital, Frankfort, IN, CCN 151316

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Witham Memorial Hospital

  dba Witham Health Services

  • Family Medicine Physician
  • Lebanon, IN
  • NPI 1083750293
  Medicare reassignment Care Compare group NPD
• Witham Memorial Hospital

  dba Witham Rehabilitation Services, Anson at Whitestown

  • Physical Therapist
  • Zionsville, IN
  • NPI 1952282204
  NPD

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

• Indiana University Health Frankfort Inc

  • Critical Access Hospital
  • Frankfort, IN
  • NPI 1346774270
  Care Compare affiliation
• Witham Memorial Hospital

  dba Witham Health Services

  • General Acute Care Hospital
  • Lebanon, IN
  • NPI 1699757401
  Care Compare affiliation

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1083110225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 N LEBANON ST STE 300",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460528622",
            "telephone_number": "765-485-8649",
            "fax_number": "765-485-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICOLE",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02006481A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300014551",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nclark@withamdirect.org",
            "affiliation": "Y",
            "affiliationName": "Witham Memorial Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2705 N Lebanon St Ste 300",
            "city": "Lebanon",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460528622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SCHMITT",
            "middle_name": "C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tae Kae Chong, MD
• Amanda Michelle Christmas, PMHNP-BC
• Adam Anthony Cieciuch, M.D.
• City Optical Co., Inc. (Dr Tavel Family Eye Care)
• Megan Clark
• Samantha Cleary
• Annita Michelle Coburn, LMFT
• Richard Coca, PHARMD
• Brianna Cole, MS, CCC-SLP
• Lisa A Conard, D.M.D.

• Family Medicine Physician in Lebanon, IN
• Providers in Lebanon, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.