Individual provider Active NPI

Wendy S Clark, FNP-BC

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1366433526
Registry record updated Oct 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71001332A Issued in IN
Practice address
1234 E. Dupont Rd.
Suite 6
Fort Wayne, IN 46825-1545
Phone
(260) 480-2600
Fax
(260) 496-8077
NPI assigned
Nov 4, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71001332A IN Primary

Addresses

Primary practice location

1234 E. Dupont Rd.
Suite 6
Fort Wayne, IN 46825-1545

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Other identifiers 2

IdentifierTypeStateIssuer
200365810MedicaidIN
500024448OtherINMEDICARE RR

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address wclark7284@Direct.Parkviewexchange.com
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20120127000107 IN Practitioner - Nurse Practitioner 7113194465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

1234 E Dupont Rd
5 PPG Cardiovascular Surgery
Fort Wayne, IN 46825-1545
Phone (260) 266-2800

Hospital & facility affiliations

  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021

Merit-based Incentive Payment System (MIPS)

Final score
83.53 of 100Reported as group
Quality
70
Promoting interoperability
100
Improvement activities
40
Cost
75.11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71001332AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Health System Inc Nurse Practitioner CurrentSince Oct 18, 2018 Accepting new patients

Locations

817 Trail Ridge Rd
Albion, IN 46701
Phone (260) 373-9590

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

1234 E DuPont Rd
Ste 6
Fort Wayne, IN 46825
Phone (260) 425-6390

1234 E DuPont Rd
Ste 5
Fort Wayne, IN 46825
Phone (260) 266-2800

3702 New Vision Dr
Bldg B
Fort Wayne, IN 46845
Phone (260) 266-8210

3909 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-8000

240 S Jefferson St
Ste B
Huntington, IN 46750
Phone (219) 259-0000

Interoperability endpoints

  • Direct secure messaging: wclark7284@direct.parkviewexchange.com

Organizations & group practices 1

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": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665792000000",
    "number": "1366433526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 E. DUPONT RD.",
            "address_2": "SUITE 6",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251545",
            "telephone_number": "260-480-2600",
            "fax_number": "260-496-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WENDY",
        "middle_name": "S",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-04",
        "last_updated": "2022-10-15",
        "certification_date": "2022-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71001332A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200365810",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "500024448",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wclark7284@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.