Clarence David Runnels III, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5011070 Issued in NC

Practice address

523 Keisler Dr Ste 202
Cary, NC 27518-7099

Phone

(919) 601-6442

NPI assigned

Oct 3, 2018

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in NC

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Apex Mental Health, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Cary, NC
  • NPI 1295515393

  Psychiatry

  Medicare reassignment NPD Authorized official
• Innovative Behavioral Health Services P.C.

  • Multi-Specialty Clinic/Center
  • Creedmoor, NC
  • NPI 1124367347

  Psychiatric/Mental Health

  Medicare reassignment NPD

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

{
    "created_epoch": "1538524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1487129649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 KEISLER DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275187099",
            "telephone_number": "919-601-6442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 KEISLER DR STE 202",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275187099",
            "telephone_number": "919-601-6442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "790 SE Cary Pkwy Ste 201",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275115678",
            "country_code": "US",
            "telephone_number": "919-354-0840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "402 N Main Street",
            "address_purpose": "LOCATION",
            "city": "Creedmoor",
            "state": "NC",
            "postal_code": "27522",
            "country_code": "US",
            "telephone_number": "919-529-2474",
            "fax_number": "919-529-2143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUNNELS",
        "first_name": "CLARENCE",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-03",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5011070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC CERTIFICATION NUMBER",
            "identifier": "2018010871",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCBON LICENSE NUMBER",
            "identifier": "5011070",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy Lee Rudolph, FNP, BC, OCN
• Brian Rue, MD
• Lauren Marie Ruff
• Kristin Ruiter
• Tayler Emmalyn Runge, BEHAVIOR TECHNICIAN
• Daniele Ellen Runyan, DC
• Melinda Rupard, PHD
• Morgan Rush
• Elizabeth Edgington Rushin, DDS
• Christopher Stanley Rusinek, MD

• Psychiatric/Mental Health Nurse Practitioner in Cary, NC
• Providers in Cary, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.