Nicolle Clements, MBBCH
Individual provider Active NPI Family Medicine Physician · Greenville, MI
NPI 1104497072 · NPPES record last updated May 31, 2022
Key facts
- NPI
- 1104497072
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4351047979 (MI)
- Practice address
- 1202 W Oak St Ste 200
Greenville, MI 48838-2155 - Phone
- (616) 754-4685
- Fax
- (616) 754-9883
- NPI assigned
- Jul 1, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210713002127 | MI | Order and Referring Only - Family Practice |
6002218047 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spectrum Health United | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 4351047979 | MI | Yes |
Addresses
Primary practice location
1202 W Oak St Ste 200
Greenville, MI 48838-2155
Mailing address
1202 W Oak St Ste 200
Greenville, MI 48838-2155
Other providers in Greenville, MI
- Edwina Childs
- Megan Christensen
- Mel Ciaravino
- Clay Street Center
- Alexander William Clegg
- Kevin Coalter
- Nicholas Comai
- Ronald Commans II
- Commnity Hope Christian Counseling Center
- Community Hope Christian Counseling & Mental Health Center
All providers in Greenville, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.