Shana Marie Clark

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3011392 Issued in KY

Practice address

6101 Terry Rd
Louisville, KY 40258-3027

Phone

(502) 807-5943

NPI assigned

Jun 26, 2017

Last updated

Jul 21, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY, IN2 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

Little Clinic of in LLCGroup PAC ID 7719118447, 66 clinicians

Kiosk Medicine Kentucky LLCGroup PAC ID 6002887510, 169 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.72 of 100Reported as group

Quality

66.02

Promoting interoperability

100

Improvement activities

40

Cost

79.72

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shana.clark@krogerhealth.eclinicaldirectplus.com

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.

• Kiosk Medicine Kentucky LLC

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1205885035
  Medicare reassignment Care Compare group NPD
• Little Clinic of in LLC

  • Family Nurse Practitioner
  • Floyds Knobs, IN
  • NPI 1558791384
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1710407218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 TERRY RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402583027",
            "telephone_number": "502-807-5943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 TERRY RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402583027",
            "telephone_number": "502-807-5943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3011392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Clark
• Paul Clark, PT, DPT
• Paul Richard Clark, RN, PHD, MA, FAEN
• Ryan Clark, LCSW, LCADC
• Shamonda Lashea Clark, MSSW, CSW
• Spencer Clark, DO
• Stephania Clark, PSY.D.
• Stephen Jeter Clark, DMD
• Susan Clark, LCSW
• Susan D. Clark, RN

• Family Nurse Practitioner in Louisville, KY
• Providers in Louisville, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.