Nicholas McKinley Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11035 Issued in AZ

Practice address

3522 N 3Rd Ave
Phoenix, AZ 85013-3903

Phone

(602) 776-7676

Fax

(602) 705-0567

NPI assigned

Apr 8, 2025

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

Medicare fee-for-service enrollment

Enrolled in AZ

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Circle the CityGroup PAC ID 3971824442, 63 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicholas.clark.1@11818.direct.athenahealth.com

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.

• Circle the City

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1346588316
  Medicare reassignment Care Compare group
• Circle the City

  • Community/Retail Pharmacy
  • Phoenix, AZ
  • NPI 1144093972
  NPD
• Circle the City

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1679954184
  NPD
• Circle the City

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1487033247
  NPD (past)

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

{
    "created_epoch": "1744070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1679367288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3522 N 3RD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133903",
            "telephone_number": "602-776-7676",
            "fax_number": "602-705-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3522 N 3RD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133903",
            "telephone_number": "602-776-7676",
            "fax_number": "602-705-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICHOLAS",
        "middle_name": "MCKINLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-08",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "11035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marion Clark, RN
• Marisa Clark
• Maryanne C Clark, PMHNP
• Matthew Austin Clark, DPT
• Melvin Jerome Clark, M.D.
• Paige N Clark, MC
• Philip Clark, LDO
• Randolph A Clark, M.D.
• Samuel T Clark II, MD
• Samuela Clark, LVN

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2026; 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.