Kristin Marie Jerome Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110003441 Issued in VA

Practice address

14010 Smoketown Rd Ste 117
Woodbridge, VA 22192-4704

Phone

(718) 920-6656

NPI assigned

Sep 1, 2009

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 VA, DC2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Inova Health Care ServicesGroup PAC ID 2466351093, 1,821 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Inova Fairfax Hospital Hospital, Falls Church, VA, CCN 490063
• Inova Alexandria Hospital Hospital, Alexandria, VA, CCN 490040

Merit-based Incentive Payment System (MIPS)

Final score

80.52 of 100Reported as group

Quality

56.13

Promoting interoperability

98

Improvement activities

40

Cost

80.61

Merit-based Incentive Payment System (MIPS)

Final score

83.36 of 100Reported as group

Quality

73.03

Promoting interoperability

100

Improvement activities

40

Cost

71.49

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kclark133633@soc.inova.org

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.

• Inova Health Care Services

  • Internal Medicine Physician
  • Falls Church, VA
  • NPI 1952320061

  DC

  Medicare reassignment Care Compare group
• Gastroenterology Associates of Northern Virginia, LLC

  • Gastroenterology Physician
  • Fairfax, VA
  • NPI 1205884368

  DC

  Medicare reassignment
• Inova Health Care Services

  • Medical Technologist
  • Sterling, VA
  • NPI 1699655589
  NPD
• Inova Health Care Services

  • Diagnostic Radiology Physician
  • Waldorf, MD
  • NPI 1851829550
  NPD
• Old Dominion Anesthesia LLC

  • Anesthesiology Physician
  • Charlottesville, VA
  • NPI 1902248677
  NPD (past)

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

• Inova Health Care Services

  • General Acute Care Hospital
  • Alexandria, VA
  • NPI 1255684460
  Care Compare affiliation
• Inova Health Care Services

  • Rehabilitation Hospital Unit
  • Falls Church, VA
  • NPI 1588795462
  Care Compare affiliation
• Inova Health Care Services

  • General Acute Care Hospital
  • Falls Church, VA
  • NPI 1831220714
  Care Compare affiliation

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

{
    "created_epoch": "1251763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459900800000",
    "number": "1528291069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14010 SMOKETOWN RD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924722",
            "telephone_number": "201-669-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14010 SMOKETOWN RD STE 117",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924704",
            "telephone_number": "718-920-6656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRISTIN",
        "middle_name": "MARIE JEROME",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-01",
        "last_updated": "2016-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110003441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Carol Clance
• Anthony Clark, LCSW
• Benjamin Ryan Clark, LPC
• Hershelle Andera Clark
• Janelle Clark, M.S.
• Taiia Clarke
• Clary Healthcare Services LLC
• C. Angela Clary-Duckworth, COTA
• Kaitlyn Nichole Clary
• Adrienne Claybaugh

• Physician Assistant in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; 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.