Tiffany Leah Clack, MSN-ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

765246 Issued in TX

Practice address

712 N. Washington Ave
Suite 415
Dallas, TX 75246-1800

Phone

(214) 820-9115

Fax

(214) 820-9135

NPI assigned

Feb 23, 2012

Last updated

Mar 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Enhabit Home Health Home health agency, Allen, TX, CCN 457789
• Accentcare Home Health of McKinney Home health agency, McKinney, TX, CCN 679236
• Baylor Scott and White Medical Center McKinney Hospital, MC Kinney, TX, CCN 670082
• Baylor Scott & White Medical Center Plano Hospital, Plano, TX, CCN 450890

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthtexas Provider Network

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1760488936
  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services Inc.

  • Physical Therapist
  • Cedar Park, TX
  • NPI 1871132357
  Care Compare group
• Healthtexas Provider Network

  • Family Medicine Physician
  • Plano, TX
  • NPI 1003811639
  NPD
• Healthtexas Provider Network

  dba Symmetry Anesthesia

  • Anesthesiology Physician
  • Lakeway, TX
  • NPI 1104714583
  NPD

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

• Baylor Regional Medical Center at Plano

  dba Baylor Scott & White Medical Center - Plano

  • General Acute Care Hospital
  • Plano, TX
  • NPI 1649273434
  Care Compare affiliation
• Baylor Scott & White Medical Centers - Greater North Texas

  dba Baylor Scott & White Medical Center - McKinney

  • General Acute Care Hospital
  • McKinney, TX
  • NPI 1124305065
  Care Compare affiliation
• Texas Home Health Group of McKinney, LLC

  dba AccentCare Home Health of McKinney

  • Home Health Agency
  • McKinney, TX
  • NPI 1639609084
  Care Compare affiliation
• Texas Senior Care, LP

  dba Enhabit Home Health

  • Home Health Agency
  • Allen, TX
  • NPI 1851361166
  Care Compare affiliation

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1376817221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 N WASHINGTON AVE",
            "address_2": "SUITE 415",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461619",
            "telephone_number": "214-820-9115",
            "fax_number": "214-820-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 N. WASHINGTON AVE",
            "address_2": "SUITE 415",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461800",
            "telephone_number": "214-820-9115",
            "fax_number": "214-820-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLACK",
        "first_name": "TIFFANY",
        "middle_name": "LEAH",
        "credential": "MSN-ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-23",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "765246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "294800201",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tlackey225672@direct.sw.org",
            "affiliation": "N",
            "address_1": "712 N. Washington Ave",
            "address_2": "Suite 415",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752461800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clan Iom, PLLC

• Adult Health Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Adult Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.