Annette M Clark, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

112234 Issued in TX

Practice address

2900 E 29TH St
Bryan, TX 77802-2622

Phone

(979) 776-8400

Fax

(877) 601-5854

NPI assigned

Jul 31, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Aandm University System Health Science CenterGroup PAC ID 8224008644, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Texas a&M University System Health Science Center

  • Family Medicine Physician
  • Bryan, TX
  • NPI 1063699312
  Medicare reassignment Care Compare group NPD
• Texas a&M University System Health Science Center

  • Rural Health Clinic/Center
  • Navasota, TX
  • NPI 1558140004
  NPD

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

{
    "created_epoch": "1438300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1366828477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ELTON HILLS LN NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013577",
            "telephone_number": "507-282-1009",
            "fax_number": "507-282-0932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 E 29TH ST",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022622",
            "telephone_number": "979-776-8400",
            "fax_number": "877-601-5854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANNETTE",
        "middle_name": "M",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-31",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "11843",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "112234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christus Continuing Care
• Abbey Ann CHRZ, PT, DPT
• Kuo-Hong Chuang
• Jim Hudson Chung, M.D.
• City of Bryan
• Jennifer Bowlin Clark, COTA
• Joan Marie Clark, L.P.C.
• Katie Louise Clark, RN
• Brenda Kay Clarke, FNP-C
• Cliff Walker Chiropractic, PC

• Clinical Social Worker in Bryan, TX
• Providers in Bryan, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.