Stacey Clark, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0622 Issued in NH

Practice address

4 Crescent St.
Penacook, NH 03303-1412

Phone

(603) 753-4302

Fax

(603) 227-7570

NPI assigned

Nov 8, 2005

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

Other identifiers 1

Other names 1

• Stacey Ort Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NH

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, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Concord Hospital IncGroup PAC ID 6103721790, 572 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Granite Vna, Inc Home health agency, Concord, NH, CCN 307000
• Concord Hospital Hospital, Concord, NH, CCN 300001
• Concord Hospital- Franklin Hospital, Franklin, NH, CCN 301306
• Concord Hospital- Laconia Hospital, Laconia, NH, CCN 300005

Merit-based Incentive Payment System (MIPS)

Final score

89 of 100Reported as apm

Quality

73.23

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Concord Hospital, Inc.

  • Emergency Medicine Physician
  • Concord, NH
  • NPI 1194778571
  Medicare reassignment Care Compare group
• Concord Hospital, Inc.

  • Psychiatric Hospital Unit
  • Concord, NH
  • NPI 1124070966
  NPD
• Concord Hospital, Inc.

  • General Practice Physician
  • Concord, NH
  • NPI 1801840764
  NPD
• Emergency Physicians of Derry PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Derry, NH
  • NPI 1730232232
  NPD (past)
• Granite State Emergency Physicians PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Manchester, NH
  • NPI 1619038023
  NPD (past)
• Merrimack Emergency Physicians

  • Emergency Care Clinic/Center
  • Manchester, NH
  • NPI 1881635837
  NPD (past)
• Team Physicians of Arizona PC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1710915764

  Physician Assistant

  NPD (past)

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

• Concord Hospital-Franklin

  • Critical Access Hospital
  • Franklin, NH
  • NPI 1700960895
  Care Compare affiliation
• Concord Hospital-Laconia

  • General Acute Care Hospital
  • Laconia, NH
  • NPI 1053495234
  Care Compare affiliation
• Concord Hospital-Laconia

  • Family Medicine Physician
  • Laconia, NH
  • NPI 1053993741

  Hospital

  Care Compare affiliation
• Concord Hospital, Inc.

  • General Acute Care Hospital
  • Concord, NH
  • NPI 1215988530
  Care Compare affiliation
• Granite Vna, Inc.

  • Home Health Agency
  • Concord, NH
  • NPI 1164425583
  Care Compare affiliation

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1710968763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CRESCENT ST",
            "city": "PENACOOK",
            "state": "NH",
            "postal_code": "033031412",
            "telephone_number": "603-753-4302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CRESCENT ST.",
            "city": "PENACOOK",
            "state": "NH",
            "postal_code": "033031412",
            "telephone_number": "603-753-4302",
            "fax_number": "603-227-7570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Elliot Way",
            "address_2": "Merrimack Emergency Physicians",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "NH",
            "postal_code": "03103",
            "country_code": "US",
            "telephone_number": "603-663-2830",
            "fax_number": "603-663-1849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STACEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-08",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "2511",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "0622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3073660",
            "state": "NH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "srclark@crhc.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Concord Hospital Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "4 Crescent St.",
            "city": "Penacook",
            "state": "NH",
            "country_code": "US",
            "postal_code": "033031412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "ORT",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael Brad Abrams, O.D.
• Meghan C Baron, PA-C
• Lea Britton
• Jennifer Harkabus Burritt, MS, OTR/L
• Caring Connections Home Care LLC
• Christie Couture
• Peter Allen Dalpra, LADC
• Soheila F Degieux, DDS
• Olivia Alexandria Duggan, PHARMD
• Brett A. Dunn, PHARMD, RPH

• Physician Assistant in Penacook, NH
• Providers in Penacook, NH by specialty
• Physician Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.