NPIMap

Individual provider Active NPI

Kimberly Sue Clark, FNP-BC

  • Family Nurse Practitioner
  • Harbor Springs, MI
National Provider Identifier
1386942837
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704254566 Issued in MI
Practice address
8881 M 119
Harbor Springs, MI 49740
Phone
(231) 347-5400
Fax
(231) 348-2515
NPI assigned
Mar 8, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704254566 MI Primary

Addresses

Primary practice location

8881 M 119
Harbor Springs, MI 49740

Mailing address

8881 M 119
Harbor Springs, MI 49740-9586
Phone (231) 347-5400

Other practice location 1

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-5000

Other identifiers 1

IdentifierTypeStateIssuer
4704254566OtherMISTATE OF MICHIGAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140317000852 MI Practitioner - Nurse Practitioner 1153552120 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Saginaw Valley Medical College - NLG, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Munson Medical GroupGroup PAC ID 8820277015, 191 clinicians

Practice addresses (Care Compare)

8881 M
Suite 119
Harbor Springs, MI 49740-9586
Phone (231) 347-5400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Group CurrentSince Jan 1, 2022 Accepting new patients
Munson Medical Center CurrentSince Mar 1, 2022 Accepting new patients
Munson Medical Group Current Accepting new patients
Munson Medical Center Current Accepting new patients
Munson Medical Group CurrentSince Jan 1, 2022 Accepting new patients
Munson Medical Center CurrentSince Mar 1, 2022 Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

2891 Momentum Pl
Chicago, IL 60689

8881 M 119
Harbor Springs, MI 49740
Phone (231) 347-5400

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1200 Sixth St
Ste 200
Traverse City, MI 49684

Interoperability endpoints

  • Direct secure messaging: kclark7@direct.mhc.net

Organizations & group practices 7

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 7

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": "1299542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1386942837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8881 M 119",
            "city": "HARBOR SPRINGS",
            "state": "MI",
            "postal_code": "497409586",
            "telephone_number": "231-347-5400",
            "fax_number": "231-348-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8881 M 119",
            "city": "HARBOR SPRINGS",
            "state": "MI",
            "postal_code": "49740",
            "telephone_number": "231-347-5400",
            "fax_number": "231-348-2515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 Sixth St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842345",
            "country_code": "US",
            "telephone_number": "231-935-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-08",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704254566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MICHIGAN",
            "identifier": "4704254566",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harbor Springs, MI

Sources for this page

Verify at the official NPI Registry.