Jeremy Clark, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-178487 Issued in AL

Practice address

810 Saint Vincents Dr
Birmingham, AL 35205-1601

Phone

(904) 372-3943

Fax

(904) 212-1618

NPI assigned

Aug 14, 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

Medicare fee-for-service enrollment

Enrolled in AL

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

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Diabetes Management Partners LLCGroup PAC ID 9436435385, 66 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Vincent'S Birmingham Hospital, Birmingham, AL, CCN 010056
• St. Vincent'S East Hospital, Birmingham, AL, CCN 010011
• University of Alabama Hospital Hospital, Birmingham, AL, CCN 010033

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Diabetes Management Partners LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Bethpage, NY
  • NPI 1013461193

  AL

  Medicare reassignment Care Compare group NPD
• Alabama Physicians Group LLC

  • Emergency Medicine Physician
  • Anniston, AL
  • NPI 1750062527
  Medicare reassignment NPD
• Diabetes Management Partners LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Bel Air, MD
  • NPI 1245101617
  NPD

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

• St. Vincent'S Birmingham

  • General Acute Care Hospital
  • Birmingham, AL
  • NPI 1841298999
  Care Compare affiliation
• St. Vincent'S East

  • General Acute Care Hospital
  • Birmingham, AL
  • NPI 1841308020
  Care Compare affiliation
• University of Alabama at Birmingham

  • General Acute Care Hospital
  • Birmingham, AL
  • NPI 1154435824
  Care Compare affiliation
• University of Alabama at Birmingham

  • General Acute Care Hospital
  • Birmingham, AL
  • NPI 1447145818
  Care Compare affiliation

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1699458935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7751 BELFORT PKWY STE 120",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566921",
            "telephone_number": "904-372-3943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 SAINT VINCENTS DR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352051601",
            "telephone_number": "904-372-3943",
            "fax_number": "904-212-1618"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 Eminence Way Ste A",
            "address_purpose": "LOCATION",
            "city": "Pell City",
            "state": "AL",
            "postal_code": "351282338",
            "country_code": "US",
            "telephone_number": "205-884-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JEREMY",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-14",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-178487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis Mark Clark, D.M.D., M.D
• Elizabeth Clark
• Grayson Powell Clark, MD
• Jacqueline Marie Clark, RN
• James M. Clark, DMD
• Jessica Clark, RN
• Judy Njeri Clark
• Kailey Rae Clark, AUD
• Katelynn Nikole Clark, MS
• Katherine Whiteside Clark, M.A., L.P.C.

• Family Nurse Practitioner in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.