Timetra Diane Clark, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209024791 Issued in IL

Practice address

1401 E 55TH St Apt 905N
Chicago, IL 60615-5468

Phone

(708) 759-3112

NPI assigned

Apr 1, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, IN2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Healing Partners Plus PLLC

  • Internal Medicine Physician
  • Naperville, IL
  • NPI 1063217545
  Medicare reassignment NPD
• Senf NP Family Medicine PLLC

  • Surgery Physician
  • Schaumburg, IL
  • NPI 1821702432
  Medicare reassignment NPD
• Trio Health Medical Il NP Partners PLLC

  • Nurse Practitioner
  • Evanston, IL
  • NPI 1497637011
  Medicare reassignment
• Consonant Healing Associates of de LLC

  • Surgery Physician
  • Sparks, MD
  • NPI 1669099321

  IN

  Medicare reassignment

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

{
    "created_epoch": "1648771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1316687650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 E 55TH ST APT 905N",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606155468",
            "telephone_number": "708-759-3112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E 55TH ST APT 905N",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606155468",
            "telephone_number": "708-759-3112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11026 Pony Gate",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782545999",
            "country_code": "US",
            "telephone_number": "847-616-0269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIMETRA",
        "middle_name": "DIANE",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-01",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WN0300X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nephrology",
            "state": "IL",
            "license": "041436444",
            "primary": false
        },
        {
            "code": "163WN0300X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nephrology",
            "state": "FL",
            "license": "9562544",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209024791",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209024791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "timetra.type.of.care@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1401 E 55th St Apt 905N",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606155468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stacy Clark, PH.D.
• Stephanie Clark, LCPC
• Stephanie Borjas Clark, PHD
• Susan Leighton Clark, LCSW
• Therese Michelle Clark, DPT
• William M Clark Jr., M.D.
• Alison Claire Clarke, FNP-C
• Aymara Maeve Soicher Clarke, MS
• Brianna Clarke
• Clifton Clarke, MD

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; 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.