Donald Lee Clark III, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209019719 Issued in IL

Practice address

2100 Madison Ave
Granite City, IL 62040-4713

Phone

(618) 798-3000

NPI assigned

Aug 30, 2019

Last updated

Aug 30, 2019By the provider in NPPES

Sex

Male

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 IL

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Trinity Medical Staffing LLCGroup PAC ID 1759712698, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jersey Community Hospital Hospital, Jerseyville, IL, CCN 140059
• Marshall Browning Hospital Hospital, Du Quoin, IL, CCN 141331
• Deaconess Illinois Crossroads Hospital, Mount Vernon, IL, CCN 140294
• Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020
• Marshall Browning Hospital Nursing home, CCN 14Z331

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dclar120@yourcarecommunity.org
• Direct secure messaging: dclark524328@direct-ehr-ssmhc.com
• FHIR API: https://fhir-usa.unify.chbase.com/org/hamilto-2525a05c

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Trinity Medical Staffing LLC

  • Internal Medicine Physician
  • Harrisburg, IL
  • NPI 1770103426
  Medicare reassignment Care Compare group NPD
• Ahs Il Medical Group LLC

  • Clinic/Center
  • Granite City, IL
  • NPI 1659098101
  Medicare reassignment NPD
• Deaconess Illinois Specialty Clinic, Inc.

  dba Deaconess IL Specialty 3331 DeYoung

  • Surgery Physician
  • Marion, IL
  • NPI 1972210235
  Medicare reassignment NPD
• Emergency Services Midwest SC

  • Emergency Medicine Physician
  • Belleville, IL
  • NPI 1174024806
  Medicare reassignment NPD
• Granite City Hospitalist Services LLC

  • Hospitalist Physician
  • Carbondale, IL
  • NPI 1669926424
  Medicare reassignment NPD
• Hamilton Memorial Hospital District

  dba Hamilton Memorial Family Clinic

  • Rural Health Clinic/Center
  • McLeansboro, IL
  • NPI 1609837665
  Medicare reassignment NPD
• Morrison Community Hospital District

  • Critical Access Hospital
  • Morrison, IL
  • NPI 1184844938
  Medicare reassignment NPD
• Morrison Community Hospital District

  • Family Medicine Physician
  • Morrison, IL
  • NPI 1700907250
  Medicare reassignment NPD
• Statera Health Care, LLC

  • Emergency Medicine Physician
  • Harrisburg, IL
  • NPI 1043874449
  Medicare reassignment NPD
• Deaconess Illinois Specialty Clinic, Inc.

  dba Deaconess Care Group Illinois Union County

  • Hospitalist Physician
  • Anna, IL
  • NPI 1225858251
  NPD
• Deaconess Illinois Specialty Clinic, Inc.

  dba Deaconess Care Group Illinois

  • Hospitalist Physician
  • Marion, IL
  • NPI 1558067488
  NPD
• Hamilton Memorial Hospital District

  • Critical Access Hospital
  • McLeansboro, IL
  • NPI 1447257258
  NPD

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

• Deaconess Illinois Crossroads Inc

  dba Crossroads Community Hospital

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1124745807
  Care Compare affiliation
• Jersey Community Hospital

  • General Acute Care Hospital
  • Jerseyville, IL
  • NPI 1184630519
  Care Compare affiliation
• Marshall Browning Hospital Association

  • Critical Access Hospital
  • Du Quoin, IL
  • NPI 1821099441
  Care Compare affiliation
• Mercy Hospitals East Communities

  dba Mercy Hospital St Louis

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1427098169
  Care Compare affiliation
• Mercy Hospitals East Communities

  dba Mercy St. Louis Transport Ambulance

  • Land Ambulance
  • Saint Louis, MO
  • NPI 1881329902

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1567123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1366090573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8308 BURLINGTON DR",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622944003",
            "telephone_number": "618-402-3946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404713",
            "telephone_number": "618-798-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DONALD",
        "middle_name": "LEE",
        "name_suffix": "III",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-30",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209019719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cescelli Paige Childs, LPN
• Stacey L Choat, RPH
• CHR-Ash Inc (Medicine Shoppe)
• City of Granite City
• Debra Ann Clark, RN
• Janel L. Clark, FNP
• Clarkson Optometry Illinois PC (Clarkson Eyecare)
• Clarkson Optometry Illinois, P.C. (Clarkson Eyecare)
• Elizabeth Cline
• Clinical Counseling Associates, Inc (Clinical Counseling Associates)

• Family Nurse Practitioner in Granite City, IL
• Providers in Granite City, 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 Aug 30, 2019; 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.