Nellda C Clark, CRNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

1-0473524 Issued in AL

Practice address

440 Taylor Rd
3300
Montgomery, AL 36117-3588

Phone

(334) 265-7075

Fax

(334) 261-6113

NPI assigned

Jun 30, 2005

Last updated

Feb 8, 2011By 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

Medicare fee-for-service enrollment

Enrolled in AL

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

University of Alabama School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson Hospital and Clinic, IncGroup PAC ID 0547254153, 119 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jackson Hospital & Clinic Inc Hospital, Montgomery, AL, CCN 010024

Merit-based Incentive Payment System (MIPS)

Final score

86.48 of 100Reported as individual

Quality

58.98

Promoting interoperability

100

Improvement activities

40

Cost

88.34

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.372198
• Direct secure messaging: nellda.clark.1@9186.direct.athenahealth.com
• Direct secure messaging: nellda.clark@direct.baptistfirst.org

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.

• Jackson Hospital and Clinic, Inc.

  • Emergency Medicine Physician
  • Montgomery, AL
  • NPI 1073264107
  Medicare reassignment Care Compare group NPD
• Jackson Hospital & Clinic, Inc.

  dba Jackson Pelvic Floor Therapy

  • Physical Therapist
  • Montgomery, AL
  • NPI 1265325823
  NPD
• Jackson Hospital and Clinic Inc

  dba Jackson Clinic Cardiology

  • Cardiovascular Disease Physician
  • Montgomery, AL
  • NPI 1912362773
  NPD
• Alabama Vascular Specialists, PC

  • Vascular Surgery Physician
  • Montgomery, AL
  • NPI 1033840269
  NPD (past)
• Jackson Hospital & Clinic, Inc.

  • General Acute Care Hospital
  • Montgomery, AL
  • NPI 1043262488
  NPD (past)

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

• Jackson Hospital & Clinic, Inc.

  • General Acute Care Hospital
  • Montgomery, AL
  • NPI 1043262488
  Care Compare affiliation

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297123200000",
    "number": "1407853880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 TAYLOR RD",
            "address_2": "3230",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173588",
            "telephone_number": "334-265-7075",
            "fax_number": "334-261-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 TAYLOR RD",
            "address_2": "3300",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173588",
            "telephone_number": "334-265-7075",
            "fax_number": "334-261-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NELLDA",
        "middle_name": "C",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2011-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-0473524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey S Clark, COUNSELOR
• Latoya Shantel Clark, MD
• Lori Johnson Clark, R.PH
• Marquivia D Clark, PHARMD
• Mary L Clark, MS, LPC
• Susan Noble Clark
• Claudias Place Inc. (N/a)
• Jeremy Alonzo Clausell
• Meagan T Clausell
• Kaitlyn Claybrook, PHARMD

• Acute Care Nurse Practitioner in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Acute Care Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2011; 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.