Donald Lee Clark III, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Granite City, IL
NPI 1366090573 · NPPES record last updated Aug 30, 2019
Key facts
- NPI
- 1366090573
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209019719 (IL)
- Practice address
- 2100 Madison Ave
Granite City, IL 62040-4713 - Phone
- (618) 798-3000
- NPI assigned
- Aug 30, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Trinity Medical Staffing LLC
Practice addresses (Care Compare)
400 Maple Summit Rd
Jerseyville, IL 62052-2028
Phone (618) 498-6402
Hospital & facility affiliations
- Jersey Community Hospital
- Marshall Browning Hospital
- Deaconess Illinois Crossroads
- Mercy Hospital St Louis
- Marshall Browning Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191029000651 | IL | Practitioner - Nurse Practitioner | 3971835786 | Reassigns benefits to 9 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209019719 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morrison Community Hospital District | Current | Accepting new patients | |
| Morrison Community Hospital District | Current | Accepting new patients | |
| Marshall Browning Hospital Association | Current |
Accepting new patients | |
| Trinity Medical Staffing LLC | Current |
Accepting new patients | |
| Morrison Community Hospital District | Family | Current |
Accepting new patients |
| Statera Health Care, LLC | Current |
Accepting new patients | |
| Ahs Il Medical Group LLC | Current |
Accepting new patients | |
| Deaconess Illinois Specialty Clinic, Inc. | Current |
Accepting new patients | |
| Hamilton Memorial Hospital District | Current |
Accepting new patients | |
| Marshall Browning Hospital Association | Current |
Accepting new patients | |
| Granite City Hospitalist Services LLC | Current |
Accepting new patients | |
| Emergency Services Midwest SC | Current |
Accepting new patients | |
| Hamilton Memorial Hospital District | Current | Accepting new patients | |
| Hamilton Memorial Hospital District | Current |
Accepting new patients | |
| Deaconess Illinois Specialty Clinic, Inc. | Current | Accepting new patients | |
| Deaconess Illinois Specialty Clinic, Inc. | Current |
Accepting new patients | |
| Deaconess Illinois Clinic, Inc | Past | Accepting new patients |
Locations
1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870
517 N Main St
Anna, IL 62906
Phone (618) 833-2295
2250 N Illinois Ave
Carbondale, IL 62901
Phone (618) 833-1691
1112 Oak St
Carmi, IL 62821
Phone (217) 732-9651
1112 Oak St
Ste 102
Carmi, IL 62821
Phone (618) 382-5030
900 N Washington St
Du Quoin, IL 62832
Phone (618) 542-1050
4273 S State Route 159
Glen Carbon, IL 62034
Phone (618) 288-2297
2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000
100 Dr Warren Tuttle Dr
Harrisburg, IL 62946
Phone (618) 252-4956
303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050
400 Maple Summit Rd
Jerseyville, IL 62052
Phone (618) 498-6402
3333 W Deyoung St
Marion, IL 62959
Phone (618) 998-7020
611 S Marshall Ave
Mc Leansboro, IL 62859
Phone (618) 542-2146
303 N Jackson St
Morrison, IL 61270
Phone (815) 772-4003
657 W Lincolnway
Morrison, IL 61270
Phone (815) 772-4003
8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500
4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750
509 Hamacher St
Waterloo, IL 62298
Phone (618) 939-3939
Interoperability endpoints
- dclar120@yourcarecommunity.org
- dclark524328@direct-ehr-ssmhc.com
- https://fhir-usa.unify.chbase.com/org/hamilto-2525a05c
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209019719 | IL | Yes |
Addresses
Primary practice location
2100 Madison Ave
Granite City, IL 62040-4713
Mailing address
8308 Burlington Dr
Troy, IL 62294-4003
Phone (618) 402-3946
Other providers in Granite City, IL
- Cescelli Paige Childs
- Stacey L Choat
- CHR-Ash Inc
- City of Granite City
- Debra Ann Clark
- Janel L. Clark
- Clarkson Optometry Illinois PC
- Clarkson Optometry Illinois, P.C.
- Elizabeth Cline
- Clinical Counseling Associates, Inc
All providers in Granite City, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.