Samuel Clark, FNP
Individual provider Active NPI Family Nurse Practitioner · Wells, ME
NPI 1720245673 · NPPES record last updated Jul 23, 2024
Key facts
- NPI
- 1720245673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- CNP241398 (ME)
- Practice address
- 112 Sanford Rd
Wells, ME 04090-5533 - Phone
- (207) 646-5211
- NPI assigned
- May 19, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- York Hospital
Practice addresses (Care Compare)
112 Sanford Rd
Wells, ME 04090-5533
114 Sanford Rd
Myhealth Wells
Wells, ME 04090-5533
Phone (207) 646-5211
15 Hospital Dr
York, ME 03909-1011
Phone (207) 363-4321
16 Hospital Dr
York, ME 03909-1011
Phone (207) 351-3715
277 Post Rd
Webhannet Internal Medicine of York Hospita
Moody, ME 04054-0496
Phone (207) 646-8387
Hospital & facility affiliations
- York Hospital Home Care
- Elara Caring
- York Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241007001983 | ME | Practitioner - Nurse Practitioner | 9931630589 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP241398 | ME | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| York Hospital | Current |
Accepting new patients |
Locations
112 Sanford Rd
Bldg B
Wells, ME 04090
Phone (207) 439-0410
112 Sanford Rd
Wells, ME 04090
Phone (207) 641-8100
15 Hospital Dr
York, ME 03909
Phone (207) 351-2478
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP241398 | ME | Yes |
Addresses
Primary practice location
112 Sanford Rd
Wells, ME 04090-5533
Mailing address
317 Laudholm Farm Rd
Wells, ME 04090-4707
Phone (617) 320-5256
Other providers in Wells, ME
- Brian E Kaufman, DO, LLC
- Brian E. Kaufman, D.O.,LLC
- Bruce Brokaw
- Robert P Cervenka
- Sandra Lee Cionni
- Aaron David Cloutier
- Coastal OB GYN
- Lillian Connelly
- Jeffrey T Cote
- CVS State Capital, L.L.C.
All providers in Wells, ME · Family Nurse Practitioner in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.