Individual provider Active NPI

Lauren Clark, PA-C

  • Medical Physician Assistant
  • Boulder City, NV
National Provider Identifier
1316346554
Registry record updated Oct 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA1550 Issued in NV
Practice address
895 Adams Blvd
Boulder City, NV 89005
Phone
(702) 293-0406
Fax
(702) 293-0192
NPI assigned
Aug 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1550 NV Primary

Addresses

Primary practice location

895 Adams Blvd
Boulder City, NV 89005

Mailing address

895 Adams Blvd
Boulder City, NV 89005-2235
Phone (702) 293-0406

Other practice location 1

2649 Wigwam Pkwy
Henderson, NV 89074-7367
Phone (702) 489-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20141227000053 NV Practitioner - Physician Assistant 0042533085 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Warren L Smith LTDGroup PAC ID 6800842980, 4 clinicians

Practice addresses (Care Compare)

895 Adams Blvd
Boulder City, NV 89005-2235
Phone (702) 293-0406

Hospital & facility affiliations

  • Boulder City Hospital Hospital, Boulder City, NV, CCN 291309

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Herve Bezard MD LTD Current Accepting new patients
Jim C Chiang MD LTD Current Accepting new patients
Sally Nahhas DO LTD Current Accepting new patients

Locations

895 Adams Blvd
Boulder City, NV 89005
Phone (702) 293-0406

Organizations & group practices 4

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": "1407888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1316346554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 ADAMS BLVD",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890052235",
            "telephone_number": "702-293-0406",
            "fax_number": "702-293-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 ADAMS BLVD",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "89005",
            "telephone_number": "702-293-0406",
            "fax_number": "702-293-0192"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2649 Wigwam Pkwy",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890747367",
            "country_code": "US",
            "telephone_number": "702-489-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LAUREN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-13",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA1550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder City, NV

Sources for this page

Verify at the official NPI Registry.