Melinda Clarke, MS, RN, FNP, PMHNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

344753 Issued in NY

Practice address

80 Orville Dr Ste 100
Bohemia, NY 11716-2505

Phone

(631) 500-5925

Fax

(631) 500-5979

NPI assigned

Mar 20, 2012

Last updated

Oct 18, 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Master of Science, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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.

• Action Wellness NP in Family Health PLLC

  • Family Nurse Practitioner
  • Ronkonkoma, NY
  • NPI 1295493187
  Medicare reassignment NPD Authorized official
• John T. Mather Memorial Hospital

  • Psychiatry Physician
  • Port Jefferson Station, NY
  • NPI 1376642371
  Medicare reassignment NPD
• Timothy D. Groth MD PC

  • Multi-Specialty Clinic/Center
  • Smithtown, NY
  • NPI 1720022015
  Medicare reassignment NPD
• John T Mather Memorial Hospital

  • Obesity Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
  • NPI 1366816894
  NPD
• John T Mather Memorial Hospital

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Port Jefferson, NY
  • NPI 1922486182
  NPD
• John T. Mather Memorial Hospital

  • Critical Care Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
  • NPI 1467249334
  NPD
• John T. Mather Memorial Hospital

  • Nurse Practitioner
  • Port Jefferson, NY
  • NPI 1821185109
  NPD
• John T. Mather Memorial Hospital

  dba Breast Center

  • Diagnostic Radiology Physician
  • Port Jefferson, NY
  • NPI 1891816070
  NPD

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

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1184999344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 ORVILLE DR STE 100",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117162505",
            "telephone_number": "631-500-5925",
            "fax_number": "631-500-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 ORVILLE DR STE 100",
            "city": "BOHEMIA",
            "state": "NY",
            "postal_code": "117162505",
            "telephone_number": "631-500-5925",
            "fax_number": "631-500-5979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "46 Route 25A Ste 1",
            "address_purpose": "LOCATION",
            "city": "Setauket",
            "state": "NY",
            "postal_code": "117332806",
            "country_code": "US",
            "telephone_number": "631-500-5925",
            "fax_number": "631-500-5979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "MELINDA",
        "credential": "MS, RN, FNP, PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-20",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "687063",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "344753",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "405889",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "344753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Enoch Chung Chan, MD
• Christina Leigh Chebuske, LMSW
• Cheryl Hecht, LCSW, PLLC
• Cheryl R. Buscaglia, Licensed Mental Health Counselor, PLLC
• Anna Cheung
• Lois Cloud Malenczak, P.T.
• Colleen Coffey
• Karen Ann Coffey, RN
• Community Care Health Management, LLC
• Comprehensive Ambulance Billing Services, LLC

• Nurse Practitioner in Bohemia, NY
• Providers in Bohemia, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.