Desa Mariah Clark, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

113657 Issued in NE

Practice address

2560 N Healthy Way
Fremont, NE 68025-2315

Phone

(402) 941-7245

NPI assigned

Apr 22, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Desa Mariah Eldridge Former name

Medicare fee-for-service enrollment

Enrolled in NE

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Methodist Fremont HealthGroup PAC ID 7911258520, 89 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist Fremont Health Hospital, Fremont, NE, CCN 280077

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: desa.clark@direct.nmhs.org

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.

• Methodist Fremont Health

  • Internal Medicine Physician
  • Fremont, NE
  • NPI 1235618216
  Medicare reassignment Care Compare group NPD
• Nebraska Methodist Hospital

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1427147883
  NPD

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

• Methodist Fremont Health

  • Rural Acute Care Hospital
  • Fremont, NE
  • NPI 1033698543
  Care Compare affiliation
• Methodist Fremont Health

  • Rural Acute Care Hospital
  • Fremont, NE
  • NPI 1376498543
  Care Compare affiliation

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1215519814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 E THOMSEN ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680259235",
            "telephone_number": "402-317-0797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 N HEALTHY WAY",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680252315",
            "telephone_number": "402-941-7245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DESA",
        "middle_name": "MARIAH",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-22",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NE",
            "license": "64709",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NE",
            "license": "113657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESA",
            "last_name": "ELDRIDGE",
            "middle_name": "MARIAH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cory Michael Christensen
• Hope L Christensen
• Robert Churchill III
• Jonathan M Ciochon, PHARM. D.
• City of Fremont
• Krista Carrie Clark, RD LMNT
• Andrew J Clary
• Eric Claussen
• Alecia Clinesmith
• Cassidy Coggins, MS, PLMHP

• Family Nurse Practitioner in Fremont, NE
• Providers in Fremont, NE by specialty
• Family Nurse Practitioner in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.

Verify at the official NPI Registry.