Clarke Lew Medical Corp

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

CLARKE LEW MEDICAL CORP

Doing business as

Illumination Foundation Medical Group

Practice address

3535 W Commonwealth Ave
Fullerton, CA 92833-2821

Phone

(949) 273-0555

NPI assigned

Jul 21, 2020

Last updated

Jun 9, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicole St. Claire

Title

Billing Consultant

Phone

(949) 633-5535

Specialties & licenses 13

Addresses

Other names 1

• Illumination Foundation Medical Group Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22909/brand/1/csg/1/fhir/r4

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Monika Kumari Badyal, CFNP, DNP

  • Family Nurse Practitioner
  • Fullerton, CA
  • NPI 1053681932
  NPD
• Ivy Yen Chua, MSN, FNP

  • Family Nurse Practitioner
  • San Francisco, CA
  • NPI 1053568402
  NPD
• David Han

  • Clinical Social Worker
  • Anaheim, CA
  • NPI 1134633845

  Mental Health

  NPD
• Kensie Hoag

  • Clinical Social Worker
  • Long Beach, CA
  • NPI 1265966576
  NPD
• Summer Nicole Hulsey

  • Marriage & Family Therapist
  • Stanton, CA
  • NPI 1538681770

  Addiction (Substance Use Disorder)

  NPD
• Clarke R. Lew, MD

  • Emergency Medicine Physician
  • Anaheim, CA
  • NPI 1194768077

  Family Medicine

  NPD
• Doan Qui Nguyen, MD

  • Psychiatry Physician
  • Westminster, CA
  • NPI 1336503838
  NPD
• Ogbonna Iwuamadi Olelewe, NP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Hawthorne, CA
  • NPI 1043751886
  NPD
• Perlee C Tobias, FNP

  • Family Nurse Practitioner
  • Irvine, CA
  • NPI 1508450966
  NPD

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1205444742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 W COMMONWEALTH AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928332821",
            "telephone_number": "714-402-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 W COMMONWEALTH AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928332821",
            "telephone_number": "949-273-0555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 Carnegie Ave",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927055527",
            "country_code": "US",
            "telephone_number": "949-273-0555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLARKE LEW MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-21",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "ST. CLAIRE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "BILLING CONSULTANT",
        "authorized_official_telephone_number": "949-633-5535"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illumination Foundation Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Illumination Foundation Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bethany Kristin Clark, FNP
• Carrie-Anne Clark, PA-C
• Madison Mimi Clark
• Olivia Clark
• Tracey Clark, M.A., LMFT
• Grant David Clarke, LCSW
• Marisa Clarke
• Sharray Marie Clarke
• Clarvida
• Ellianna Marie Maligaya Claudio

• Community Health Clinic/Center in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Community Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.