Jennifer Leigh Clark, AGNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704290820 Issued in MI

Practice address

100 Lake Traverse Dr
Sisseton, SD 57262-7046

Phone

(605) 698-7606

NPI assigned

May 28, 2017

Last updated

Feb 22, 2024By 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 MI, TX2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Woodrow Wilson Keeble Memorial Health Care CenterGroup PAC ID 1850295940, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Coteau Des Prairies Health Care System Hospital, Sisseton, SD, CCN 431339

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Woodrow Wilson Keeble Memorial Health Care Center

  • Clinic/Center
  • Sisseton, SD
  • NPI 1366471666

  TX

  Medicare reassignment Care Compare group NPD
• Rosebud Indian Health Service

  dba Rosebud Indian Health Service Hospital

  • General Acute Care Hospital
  • Rosebud, SD
  • NPI 1194757369

  TX

  Medicare reassignment NPD
• Careline Palliative Care LLC

  dba Optimal Care Physician Services

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Jackson, MI
  • NPI 1801367073
  Medicare reassignment NPD
• Pine Hollow Partner LLC

  • Nurse Practitioner
  • East Lansing, MI
  • NPI 1275984700
  Medicare reassignment NPD
• Rosebud Indian Health Service

  • Ambulatory Surgical Clinic/Center
  • Rosebud, SD
  • NPI 1790955128
  NPD
• Integrated Physician Solutions PC

  • Home Health Agency
  • Southfield, MI
  • NPI 1992110662
  NPD (past)

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

• Coteau Des Prairies Hospital

  dba Coteau des Prairies Health Care System

  • Critical Access Hospital
  • Sisseton, SD
  • NPI 1417051517
  Care Compare affiliation

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

{
    "created_epoch": "1495929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1679001192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LAKE TRAVERSE DR",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572627046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LAKE TRAVERSE DR",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572627046",
            "telephone_number": "605-698-7606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "middle_name": "LEIGH",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-28",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704290820",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704290820",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa M Bucklin, CNP
• Codi Cameron
• Walter W Casper, DMD
• Edward Allen Chaney, DDS
• Frances Erin Chanku, LPN
• Leroy A Clark, M.D
• Trina Marie Cleveland
• Brenda R. Collins, AGPCNP-BC
• Community Transit, Inc
• Tracey Cooper, RN

• Nurse Practitioner in Sisseton, SD
• Providers in Sisseton, SD by specialty
• Nurse Practitioner in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; 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.