Kerry Clancy, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

000102790 Issued in NC

Practice address

217 Glensford Dr
Fayetteville, NC 28314

Phone

(910) 483-4647

Fax

(910) 483-6431

NPI assigned

Aug 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Matrix Occupational Health PCGroup PAC ID 2365350220, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Matrix Occupational Health P.C.

  dba NextCare Urgent Care

  • Urgent Care Clinic/Center
  • Fayetteville, NC
  • NPI 1144279670
  Medicare reassignment Care Compare group NPD
• Cumberland County Hospital System Inc

  dba Cape Fear Valley Professional Radiology Group

  • Diagnostic Radiology Physician
  • Fayetteville, NC
  • NPI 1962299743
  NPD (past)
• Fastmed Urgent Care PC

  • Urgent Care Clinic/Center
  • Raleigh, NC
  • NPI 1225331903
  NPD (past)

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1669473153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 GLENSFORD DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283140892",
            "telephone_number": "910-483-4647",
            "fax_number": "910-483-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 GLENSFORD DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28314",
            "telephone_number": "910-483-4647",
            "fax_number": "910-483-6431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 Fairbluff Dr",
            "address_purpose": "LOCATION",
            "city": "Hope Mills",
            "state": "NC",
            "postal_code": "283485670",
            "country_code": "US",
            "telephone_number": "910-423-0804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "KERRY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "000102790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "K. CLANCY'S MEDCOST #",
            "identifier": "D7406",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Cinoski, LMBT
• Circle One Investments LLC (360 Transportation)
• Thomas Arthur Ciszek, MD
• Stephanye Clagett, LCMHCA
• Ariane Nicole Clancy, LCMHC
• Emily Slaughter Clapper
• Rio Clark Delgado
• Akilah S Clark, RBT
• Amber Clark
• Brooke Crawford Clark

• Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.