Zachary Clark

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN718903 Issued in PA

Practice address

201 State St
Erie, PA 16550-0002

Phone

(814) 877-2938

NPI assigned

Nov 16, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2026

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• St Vincent Medical Education and Research Institute Inc

  • Internal Medicine Physician
  • Erie, PA
  • NPI 1902881477
  Medicare reassignment

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

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1669247078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 STATE ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165500002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 STATE ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165500002",
            "telephone_number": "814-877-2938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ZACHARY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-16",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN718903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA RN LICENSE",
            "identifier": "RN718903",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "clarkzl3@upmc.edu",
            "affiliation": "N",
            "endpointDescription": "Hospital email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "201 State St",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165500002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eric Clark
• Garrett Clark, D.O.
• Geralynn Mary Clark
• Mindy M Clark, CNM
• Rebecca Clark, LCSW
• Maurice Orlando Clarke, LPC
• Clear Blue Holdings, Inc.
• Clearview Psychiatry PLLC
• Karen Marie Cleary-Herman
• Cynthia M Cleaves

• Registered Nurse in Erie, PA
• Providers in Erie, PA by specialty
• Registered Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.