NPIMap

Individual provider Active NPI

Kathryn M Clark, CRNA

  • Certified Registered Nurse Anesthetist
  • Durham, NC
National Provider Identifier
1558551663
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1689 Issued in NC
Practice address
3643 N Roxboro St
Durham, NC 27704-2702
Phone
(919) 470-6186
NPI assigned
Jul 26, 2007
Sex
Female
Sole proprietor
No

Organizations & group practices 28

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.

View all 28

Hospital & facility affiliations 6

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

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke University Health System, Inc 1,083 clinicians

Practice addresses (Care Compare)

2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111

Hospital & facility affiliations

  • Duke University Hospital Hospital, Durham, NC, CCN 340030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071009000854 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5193811909 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN 128359NCMDRegistered Nurse
AANA 077459NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. CurrentSince Nov 16, 2015 Accepting new patients
East Carolina Anesthesia Associates, PLLC Registered Nurse CurrentSince Oct 1, 2016 Accepting new patients
Duke University Health System, Inc. Nurse Anesthetist, Certified Registered CurrentSince Nov 16, 2015 Accepting new patients
Medstream Anesthesia PLLC Anesthesiology CurrentSince Jan 1, 2014 Accepting new patients
Amsol Anesthetists of Henderson PLLC Anesthesiology Past Accepting new patients
Durham Anesthesia Associates PA Nurse Anesthetist, Certified Registered Past Accepting new patients
Regional Anesthesia, PLLC Past Accepting new patients
North Carolina Anesthesia Partners, PLLC Anesthesiology Past Accepting new patients

Locations

82 Patton Ave
Ste 510
Asheville, NC 28801
Phone (828) 210-9386

1505 SW Cary Pkwy
Ste 100
Cary, NC 27511
Phone (919) 415-1360

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

2080 W Arlington Blvd
Ste B
Greenville, NC 27834
Phone (252) 752-2140

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

566 Ruin Creek Rd
Henderson, NC 27536
Phone (252) 436-1352

830 Rockford St
Mount Airy, NC 27030
Phone (336) 719-7000

1135 Carthage St
Sanford, NC 27330
Phone (910) 774-2100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN 128359 NC
Certified Registered Nurse Anesthetist 367500000X AANA 077459 NC
Certified Registered Nurse Anesthetist 367500000X 1689 NC Primary

Addresses

NPPES NPI Registry

Primary practice location

3643 N Roxboro St
Durham, NC 27704-2702

Mailing address

PO Box 15609
Durham, NC 27704-0609
Phone (919) 384-0700

Other practice location 1

2080 W Arlington Blvd Ste B
Greenville, NC 27834-3770
Phone (252) 752-2140

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 9, 2021.

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1558551663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15609",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277040609",
            "telephone_number": "919-384-0700",
            "fax_number": "919-384-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3643 N ROXBORO ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042702",
            "telephone_number": "919-470-6186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2080 W Arlington Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278343770",
            "country_code": "US",
            "telephone_number": "252-752-2140",
            "fax_number": "252-689-6502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATHRYN",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-26",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "RN 128359",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "AANA 077459",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "1689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.