NPIMap

Individual provider Active NPI

Andrew Clark, CRNP

  • Family Nurse Practitioner
  • Willow Street, PA
National Provider Identifier
1609382670
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP029864 Issued in PA
Practice address
2605 Willow Street Pike N
Willow Street, PA 17584-9510
Phone
(717) 464-2838
NPI assigned
Dec 28, 2017
Last updated
May 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP029864 PA Primary

Addresses

Primary practice location

2605 Willow Street Pike N
Willow Street, PA 17584-9510

Mailing address

2605 Willow Street Pike N
Willow Street, PA 17584-9510
Phone (717) 464-2838

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180213002868 NJ Practitioner - Nurse Practitioner 9638439540 Reassigns benefits to 2 organizations
I20240819000505 PA Practitioner - Nurse Practitioner 9638439540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2605 Willow St Pike
Penn State Med GRP South Lancaster
Willow Street, PA 17584-9510
Phone (717) 464-2838

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
65.84
Promoting interoperability
100
Improvement activities
40
Cost
77

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP029864PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ocean Health Initiatives Inc Current Accepting new patients
Ocean Health Initiatives, Inc CurrentSince Mar 1, 2018 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Aug 26, 2024 Accepting new patients
Ocean Mental Health Services Inc CurrentSince Jan 9, 2024 Accepting new patients
Ocean Health Initiatives, Inc. CurrentSince Mar 1, 2018 Accepting new patients
Penn State Health Medical Group, LLC Current Accepting new patients
Penn State Health Medical Group, LLC Family CurrentSince Aug 26, 2024 Accepting new patients
Pharma Holding Inc PastSince Jul 23, 2023 Accepting new patients
Penn State Health Medical Group, LLC Past Accepting new patients

Locations

160 US Highway 9
Bayville, NJ 08721
Phone (732) 349-1977

687 Route 9
Bayville, NJ 08721
Phone (732) 269-4849

101 2nd St
Lakewood, NJ 08701
Phone (732) 886-4809

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

Organizations & group practices 9

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1514419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778630400000",
    "number": "1609382670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 WILLOW STREET PIKE N",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849510",
            "telephone_number": "717-464-2838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 WILLOW STREET PIKE N",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849510",
            "telephone_number": "717-464-2838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANDREW",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-28",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP029864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willow Street, PA

Sources for this page

Verify at the official NPI Registry.