Kristen Nicole Clark, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010447 Issued in IL

Practice address

2435 Village Green PL
Champaign, IL 61822-7676

Phone

(800) 325-7706

Fax

(309) 829-8397

NPI assigned

Jul 12, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Physicians of Olympia Inc PSGroup PAC ID 8123916962, 13 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.08 of 100Reported as group

Quality

100

Improvement activities

40

Cost

76.93

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kclark@clarus.direct.eyemdemr.com

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.

• Eye Physicians of Olympia Inc PS

  • Ophthalmology Physician
  • Lacey, WA
  • NPI 1821165911
  Medicare reassignment Care Compare group NPD
• Eye Physicians of Olympia Inc PS

  • Corneal and Contact Management Optometrist
  • Dupont, WA
  • NPI 1033427026
  NPD

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

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312502400000",
    "number": "1306134317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 757",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617020757",
            "telephone_number": "800-325-7706",
            "fax_number": "309-829-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 VILLAGE GREEN PL",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618227676",
            "telephone_number": "800-325-7706",
            "fax_number": "309-829-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRISTEN",
        "middle_name": "NICOLE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-12",
        "last_updated": "2011-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott R Cinnamon, M.D.
• Valerie Cintron
• Brandie Ciota, LSW
• Hannah Clark, PHD
• Kelly Dawn Clark, RPH
• Sondra Clarkson, R.D., L.D.N
• Gretchen Marie Clavey, RN
• Carol J Claxon, LCSW
• Leah Clayborn, BCBA
• Chelsea K Clayton, BS MHP

• Optometrist in Champaign, IL
• Providers in Champaign, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; 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.