Thayer A Clark, DNP
Individual provider Active NPI Family Nurse Practitioner · Thomaston, CT
NPI 1477052157 · NPPES record last updated Jun 28, 2019
Key facts
- NPI
- 1477052157
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 7667 (CT)
- Practice address
- 76 Watertown Rd Ste 2F
Thomaston, CT 06787-1826 - Phone
- (860) 880-8091
- NPI assigned
- Feb 7, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Hartford Healthcare Medical Group Inc
Practice addresses (Care Compare)
55 Meriden Ave
Suite 1D
Southington, CT 06489-3239
Phone (860) 276-5144
Hospital & facility affiliations
- Hartford Healthcare at Home
- The Hospital of Central Connecticut
- Midstate Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.48 of 100
- Quality
- 83.4
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180824002571 | CT | Practitioner - Nurse Practitioner | 1557610482 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7667 | CT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Charlotte Hungerford Hospital | Current |
Accepting new patients | |
| Hartford Healthcare Medical Group, Inc | Current |
Accepting new patients | |
| The Charlotte Hungerford Hospital | Family | Current |
Accepting new patients |
| Hartford Healthcare Medical Group, Inc | Past | Accepting new patients |
Locations
55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144
76 Watertown Rd
Ste 2F
Thomaston, CT 06787
Phone (860) 880-8091
540 Litchfield St
Torrington, CT 06790
Phone (860) 496-6361
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 7667 | CT | Yes |
Addresses
Primary practice location
76 Watertown Rd Ste 2F
Thomaston, CT 06787-1826
Mailing address
20 Essex LN
Woodbury, CT 06798-2600
Phone (203) 232-2017
Other providers in Thomaston, CT
- Mark Joseph Cantin
- Care Family Counseling Services LLC
- Megan Alyse Catania
- Pamela M Cipriano
- Patricia Rose Clampett
- Counseling & Psychotherapy, Inc.
- Aaron Michael Curtiss
- Makayla Rose Descault
- Donald S Fulton OD
- Rene Drozdziel
All providers in Thomaston, CT · Family Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.