Corina Clark-Derman, FNP
Individual provider Active NPI Family Nurse Practitioner · Albany, CA
NPI 1669734778 · NPPES record last updated Sep 16, 2016
Key facts
- NPI
- 1669734778
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 21609 (CA)
- Practice address
- 500 San Pablo Ave
Albany, CA 94706-1103 - Phone
- (510) 204-8130
- NPI assigned
- Jun 14, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Sutter Bay Medical Foundation
Practice addresses (Care Compare)
3100 Telegraph Ave
Oakland, CA 94609-3239
Phone (510) 204-8290
3200 Kearney St
Fremont, CA 94538-2299
Phone (510) 490-1222
Hospital & facility affiliations
- Alta Bates Summit Medical Center
- Alta Bates Summit Medical Center - Alta Bates Camp
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120806000537 | CA | Practitioner - Nurse Practitioner | 4284880303 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21609 | CA | MD | Chiropractor |
| 772499 | CA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter Bay Medical Foundation | Current |
Accepting new patients | |
| Sutter Bay Medical Foundation | Current |
Accepting new patients |
Locations
500 San Pablo Ave
Berkeley, CA 94706
Phone (510) 204-8130
3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800
3687 Mt Diablo Blvd
Ste 200
Lafayette, CA 94549
Phone (510) 204-6660
3100 Telegraph Ave
Ste 2000
Oakland, CA 94609
Phone (510) 204-8290
12 Camino Encinas
Orinda, CA 94563
Phone (510) 204-8180
795 El Camino Real
#1112
Palo Alto, CA 94301
Interoperability endpoints
- cclarkdermannp132768@hisp.ehr.sutterhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 772499 | CA | |
| Family Nurse Practitioner | 363LF0000X | 21609 | CA | Yes |
Addresses
Primary practice location
500 San Pablo Ave
Albany, CA 94706-1103
Mailing address
3687 Mt Diablo Blvd
S
Lafayette, CA 94549-3717
Other providers in Albany, CA
- Christopher W. Leyster, DDS, a Professional Corporation
- Damon Cianci
- Christine Ciavarella
- Cindy Hill-Ford
- City of Albany Fire Department
- Andrea Clark
- Betsy Cohen
- George David Cohen
- Stefan B. Cohen
- Evan Scott Collier
All providers in Albany, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.