Individual provider Active NPI

Cynthia Anne Clark, F.N.P.

  • Family Nurse Practitioner
  • Lumberton, NC
National Provider Identifier
1295824910
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
200746 Issued in NC
Practice address
2934 N Elm St Ste B
Lumberton, NC 28358-2987
Phone
(910) 272-1175
Fax
(910) 272-1176
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 200746 NC
Family Nurse Practitioner 363LF0000X 200746 NC Primary

Addresses

Primary practice location

2934 N Elm St Ste B
Lumberton, NC 28358-2987

Mailing address

5221 Paramount Pkwy Ste 220
Morrisville, NC 27560-5490

Other practice location 1

16 3rd Street
Dublin, NC 28332
Phone (910) 862-3528

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cclark224066@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20140110001465 NC Practitioner - Nurse Practitioner 5890923239 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Integrated CareGroup PAC ID 3173806346, 5 clinicians

Practice addresses (Care Compare)

105 Farm Brook Dr
Lumberton, NC 28358-2179
Phone (910) 738-7789

Hospital & facility affiliations

  • Southeastern Regional Medical Center Hospital, Lumberton, NC, CCN 340050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Goshen Medical Center, Incorporated Current Accepting new patients
Unc Physicians Network LLC CurrentSince Sep 4, 2022 Accepting new patients
Goshen Medical Center Incorporated CurrentSince May 19, 2016 Accepting new patients
Goshen Medical Center Incorporated CurrentSince May 19, 2016 Accepting new patients
Unc Physicians Network LLC Current Accepting new patients
Southeastern Integrated Care CurrentSince Sep 1, 2024 Accepting new patients
Bladen Healthcare LLC Past Accepting new patients

Locations

940 Martin Luther King Jr Blvd
Chapel Hill, NC 27514
Phone (919) 942-5123

444 SW Center St
Faison, NC 28341
Phone (910) 267-0421

3005 N Elm St
Lumberton, NC 28358
Phone 91067150005032

105 Farm Brook Dr
Lumberton, NC 28358
Phone (910) 738-7789

2934 N Elm St
Ste B
Lumberton, NC 28358
Phone (910) 272-1175

5221 Paramount Pkwy
Ste 220
Morrisville, NC 27560
Phone (984) 215-4110

923 W 3rd St
Ste C
Pembroke, NC 28372
Phone (910) 521-0564

Interoperability endpoints

  • Direct secure messaging: cynthia.clark.1@25516.direct.athenahealth.com
  • Direct secure messaging: cclark224066@direct.unc.nchie.net
  • Direct secure messaging: cclark@goshenmedical.cloudcraftdirect.com

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1295824910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5221 PARAMOUNT PKWY STE 220",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275605490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2934 N ELM ST STE B",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283582987",
            "telephone_number": "910-272-1175",
            "fax_number": "910-272-1176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16 3rd Street",
            "address_purpose": "LOCATION",
            "city": "Dublin",
            "state": "NC",
            "postal_code": "28332",
            "country_code": "US",
            "telephone_number": "910-862-3528",
            "fax_number": "910-862-2207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CYNTHIA",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "200746",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "200746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cclark224066@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2934 N Elm St Ste B",
            "city": "Lumberton",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283582987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lumberton, NC

Sources for this page

Verify at the official NPI Registry.