Victoria Dene Clark

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

4704276153 Issued in MI

Practice address

24111 Southfield Rd
Southfield, MI 48075-2841

Phone

(248) 557-8800

Fax

(248) 557-8860

NPI assigned

Jun 17, 2014

Last updated

Nov 20, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 MI

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

LTC Physician Care PCGroup PAC ID 8224496575, 17 clinicians

Practice addresses (Care Compare)

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.

• LTC Physician Care PC

  • Geriatric Medicine (Family Medicine) Physician
  • Bingham Farms, MI
  • NPI 1841991817
  Medicare reassignment Care Compare group NPD
• Muksi, LLC

  • Family Medicine Physician
  • Lathrup Village, MI
  • NPI 1003084492
  Medicare reassignment NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  Nurse Practitioner

  Medicare reassignment NPD
• Matrix Medical Plus

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1376973461

  MI

  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MI, Nurse Practitioner

  Medicare reassignment NPD
• Advocates in Home Health Care PC

  • General Practice Physician
  • Troy, MI
  • NPI 1154697993
  NPD
• Center Street Pharmacy PLLC

  dba Center Street Pharmacy

  • Community/Retail Pharmacy
  • Northville, MI
  • NPI 1043109259
  NPD (past)
• Wellbridge of Clarkston, LLC

  • Skilled Nursing Facility
  • Independence Township, MI
  • NPI 1669965299
  NPD (past)

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

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1417361502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30760 NELSON CIRCLE",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "48186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24111 SOUTHFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752841",
            "telephone_number": "248-557-8800",
            "fax_number": "248-557-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "VICTORIA",
        "middle_name": "DENE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-17",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704276153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nariya Lynn Clark
• Nicole Clark
• Raynell Theresa Clark, M.A. CCC-SLP
• Tanya Marie Clark, J.D.
• Tina Clark
• Clark&Associates Psychological Services, P.C.
• Timothy Clarkson
• Classified Group LTD
• Chad Claus, D.O.
• Angela L Clauson, LMSW

• Adult Health Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Adult Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; 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.