Active NPI
Nicole M Clark, PA-C
- Physician Assistant
- Saluda, SC
National Provider Identifier
1114164142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2017
- Practice address
- 595 Newberry Hwy
Saluda, SC 29138-7808 - Phone
- (864) 445-2500
- Fax
- (864) 445-3956
- NPI assigned
- Jan 13, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
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.
-
- Diagnostic Radiology Physician
- Greenwood, SC
- NPI 1659839694
-
- Rural Health Clinic/Center
- Saluda, SC
- NPI 1184219214
-
- Neurological Surgery Physician
- Greenwood, SC
- NPI 1902277270
-
- Family Medicine Physician
- Saluda, SC
- NPI 1992769665
-
- Gastroenterology Physician
- Greenwood, SC
- NPI 1841047560
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Pain Medicine (Anesthesiology) Physician
- Greenwood, SC
- NPI 1013867498
Hospital
-
- Pain Medicine (Anesthesiology) Physician
- Clinton, SC
- NPI 1720938103
Hospital
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Self Medical Group
Practice addresses (Care Compare)
160 Academy Ave
Greenwood, SC 29646-3808
Phone (864) 223-8090
Hospital & facility affiliations
- Self Regional Healthcare
- Edgefield County Healthcare an Affiliate of Self R
- Newberry County Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.7 of 100
- Quality
- 89.4
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131226000996 | SC | Practitioner - Physician Assistant | 7810053212 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Self Medical Group | Current | Accepting new patients | |
| Self Medical Group | Current | Accepting new patients | |
| Self Medical Group | Past | Accepting new patients | |
| Riley Family Practice Associates PA | Past | Accepting new patients |
Locations
75 Remittance Dr
Dept 6764
Chicago, IL 60675
2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866
3165 Newberry Hwy
Saluda, SC 29138
Phone (864) 445-2500
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2017 | SC | Primary |
Addresses
Primary practice location
595 Newberry Hwy
Saluda, SC 29138-7808
Mailing address
595 Newberry Hwy
Saluda, SC 29138-7808
Phone (864) 445-2500
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nclark167245@selfregional.direct-ci.net |
NPI Registry JSON
{
"created_epoch": "1231804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640044800000",
"number": "1114164142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "595 NEWBERRY HWY",
"city": "SALUDA",
"state": "SC",
"postal_code": "291387808",
"telephone_number": "864-445-2500",
"fax_number": "864-445-3956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "595 NEWBERRY HWY",
"city": "SALUDA",
"state": "SC",
"postal_code": "291387808",
"telephone_number": "864-445-2500",
"fax_number": "864-445-3956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "NICOLE",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-13",
"last_updated": "2021-12-21",
"certification_date": "2021-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "2017",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "nclark167245@selfregional.direct-ci.net",
"affiliation": "N",
"address_1": "595 Newberry Hwy",
"city": "Saluda",
"state": "SC",
"country_code": "US",
"postal_code": "291387808",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saluda, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.