Karla Denise Clubine, FNP/PNP
Individual provider Active NPI Family Nurse Practitioner · Brookfield, MO
NPI 1265423461 · NPPES record last updated Dec 5, 2008
Key facts
- NPI
- 1265423461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 128465 (MO)
- Practice address
- 130 E Lockling St
Brookfield, MO 64628-2337 - Phone
- (660) 258-1050
- Fax
- (660) 258-1052
- NPI assigned
- Nov 4, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Owned or controlled facilities with NPI records 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- General John J Pershing Memorial Hospital Association
Practice addresses (Care Compare)
130 E Lockling St
Brookfield, MO 64628-2337
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Pershing Memorial Hospital |
Hospital | Corporate Officer W-2 Managing Employee |
Nov 1, 2021 Nov 1, 2021 |
| Pershing Memorial Hospital |
Hospital | Corporate Officer W-2 Managing Employee |
Nov 1, 2021 Nov 1, 2021 |
| Community Medical Associates |
Rural health clinic | Contracted Managing Employee Corporate Director |
Nov 1, 2021 Nov 1, 2021 |
| Meadville Medical Clinic |
Rural health clinic | Contracted Managing Employee Corporate Director |
Nov 1, 2021 Nov 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100713000120 | MO | Practitioner - Nurse Practitioner | 6901938828 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| General John J Pershing Memorial Hospital Association | Current |
Accepting new patients | |
| General John J Pershing Memorial Hospital Association | Current |
Accepting new patients | |
| General John J Pershing Memorial Hospital Association | Current |
Accepting new patients |
Locations
130 E Lockling St
Brookfield, MO 64628
Phone (660) 258-1050
125 E Lockling St
Brookfield, MO 64628
Phone (660) 258-3363
101 E Hayward St
Meadville, MO 64659
Phone (660) 938-4213
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 128465 | MO | Yes |
Addresses
Primary practice location
130 E Lockling St
Brookfield, MO 64628-2337
Mailing address
22320 Highway M
Brunswick, MO 65236-2205
Phone (660) 272-3332
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 425996808 | Medicaid | MO |
Other providers in Brookfield, MO
- Pamela Brown
- Kristen Marie Butterfield
- Gail Calvert
- Audra Carriker
- Brian Alan Casebolt
- Minerva C Concepcion-Rivera
- Alexander Cosby
- Amy Creason
- Creative Pathways Residential Supports
- Michael R Crist
All providers in Brookfield, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2008. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.