Mariam Clark, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95000880 Issued in CA

Practice address

3612 1/2 E 1St St
Los Angeles, CA 90063-2326

Phone

(323) 264-7796

NPI assigned

Sep 29, 2014

Last updated

Mar 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• California Wound Healing Medical Group Inc.

  • Surgical Physician Assistant
  • Alhambra, CA
  • NPI 1235333972
  Medicare reassignment NPD
• Carrasco Podiatry Corporation

  • Podiatrist
  • Rancho Cucamonga, CA
  • NPI 1043339260
  Medicare reassignment NPD
• Healing Edge Medical Group - Ca

  • Surgical Physician Assistant
  • Alhambra, CA
  • NPI 1982432506
  Medicare reassignment NPD
• New Hope Podiatry Group Inc.

  • Foot & Ankle Surgery Podiatrist
  • Alhambra, CA
  • NPI 1447670955
  NPD (past)

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

{
    "created_epoch": "1411948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1619370194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6551 HARRINGTON CT",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917107376",
            "telephone_number": "909-613-9238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3612 1/2 E 1ST ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900632326",
            "telephone_number": "323-264-7796"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6551 Harrington Ct",
            "address_purpose": "LOCATION",
            "city": "Chino",
            "state": "CA",
            "postal_code": "917107376",
            "country_code": "US",
            "telephone_number": "909-613-9238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARIAM",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-29",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "F0714462",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95000880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khyristienne Clark
• Kyle Clark
• Le Ondra Clark, MS
• Madisyn Synclaire Clark
• Maria Clark
• Marlene Clark, RD
• Matt Clark
• Molly Clark, ACSW
• Morgan Taylor Clark
• Richard Clark, MFT

• Family Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.