NPIMap

Individual provider Active NPI

Gregory P Clark, APN

  • Family Nurse Practitioner
  • Fort Collins, CO
National Provider Identifier
1497322408
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN.0996672-NP Issued in CO
Practice address
4674 Snow Mesa Dr Ste 100
Fort Collins, CO 80528-8614
Phone
(970) 482-3712
NPI assigned
Jun 8, 2021
Last updated
Mar 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN.0996672-NP CO Primary
Registered Nurse 163W00000X RN.0130031 CO

Addresses

Primary practice location

4674 Snow Mesa Dr Ste 100
Fort Collins, CO 80528-8614

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071

Other practice location 1

1025 Pennock Pl Ste 121
Fort Collins, CO 80524-3257
Phone (970) 495-8980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20210723002962 CO Practitioner - Nurse Practitioner 6901209212 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

4674 Snow Mesa Dr
Fort Collins, CO 80528-8615
Phone (970) 482-3712

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN.0130031COMDRegistered Nurse
APN.0996672-NPCOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Mar 31, 2024 Accepting new patients
NPI 1457494304 CurrentSince Aug 22, 2021 Accepting new patients
Poudre Valley Health Care Inc. Current Accepting new patients
Poudre Valley Health Care Inc CurrentSince Aug 22, 2021 Accepting new patients
Poudre Valley Health Care,Inc Past Accepting new patients

Locations

1025 Pennock Pl
Fort Collins, CO 80524
Phone (970) 495-8800

1025 Pennock Pl
Ste 114
Fort Collins, CO 80524
Phone (970) 495-8800

1025 Pennock Pl
Ste 121
Fort Collins, CO 80524
Phone (970) 495-8800

2315 E Harmony Rd
Ste 200
Fort Collins, CO 80528

4601 Corbett Dr
Fort Collins, CO 80528
Phone (970) 207-4800

4601 S Mason St
Fort Collins, CO 80525
Phone (970) 266-3600

4674 Snow Mesa Dr
Ste 100
Fort Collins, CO 80528
Phone (970) 482-3712

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 5

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.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1497322408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4674 SNOW MESA DR STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805288614",
            "telephone_number": "970-482-3712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1025 Pennock Pl Ste 121",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805243257",
            "country_code": "US",
            "telephone_number": "970-495-8980",
            "fax_number": "970-495-8988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GREGORY",
        "middle_name": "P",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-08",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0996672-NP",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "RN.0130031",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.