Amy Jo Clark, APNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

7806-33 Issued in WI

Practice address

1621 N Taylor Dr Ste 100
Sheboygan, WI 53081-1993

Phone

(920) 452-1650

Fax

(920) 452-3594

NPI assigned

May 19, 2017

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sheboygan Physicians Group S.C.Group PAC ID 0648435214, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Nicholas Hospital Hospital, Sheboygan, WI, CCN 520044

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Sheboygan Physicians Group, SC

  • Internal Medicine Physician
  • Sheboygan, WI
  • NPI 1477819902
  Medicare reassignment Care Compare group NPD
• Matthew Oncology Associates

  • Hematology & Oncology Physician
  • Sheboygan, WI
  • NPI 1295791002
  NPD (past)
• Mueller Therapy, Inc.

  • Occupational Therapist
  • Random Lake, WI
  • NPI 1578515755
  NPD (past)

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

• St Nicholas Hospital-Sisters of the Third Order of St. Francis

  dba St. Nicholas Hospital Renal Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Sheboygan, WI
  • NPI 1427009992

  Hospital

  Care Compare affiliation
• St. Nicholas Hospital-Sisters of the Third Order of St Francis

  dba St Nicholas Hospital

  • General Acute Care Hospital
  • Sheboygan, WI
  • NPI 1730184342
  Care Compare affiliation

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

{
    "created_epoch": "1495152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1265969356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 N TAYLOR DR STE 100",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811993",
            "telephone_number": "920-452-1650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 N TAYLOR DR STE 100",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811993",
            "telephone_number": "920-452-1650",
            "fax_number": "920-452-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AMY",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-19",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "161099-30",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "7806-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aclark38503@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1621 N Taylor Dr Ste 100",
            "city": "Sheboygan",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530811993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christopherson Dental LLC
• Aaron Lee Cicchese, OTR
• Katie Jo Cicchese, DPT
• Lynn Ann Cisewski, MS-CCC/SLP
• City of Sheboygan (Sheboygan Fire Department)
• Terry L Clark, DPM
• Aaron Clayborn, SACIT
• Allison Cleereman
• Katherine C Cleveland, MD
• Robert E Cline, DDS

• Family Nurse Practitioner in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.