Clark Renwick Herniman, D.O

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

13436 Issued in ND

Practice address

2605 Circle Dr
Jamestown, ND 58401-6905

Phone

(701) 253-3650

NPI assigned

Jun 15, 2011

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 ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Ohio University, College of Osteopathic Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Dakota State HospitalGroup PAC ID 5698734374, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• North Dakota State Hospital

  • Psychiatric Hospital
  • Jamestown, ND
  • NPI 1649227075
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1720373996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 7TH ST NW",
            "city": "VALLEY CITY",
            "state": "ND",
            "postal_code": "580722539",
            "telephone_number": "713-805-9265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 CIRCLE DR",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584016905",
            "telephone_number": "701-253-3650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNIMAN",
        "first_name": "CLARK",
        "middle_name": "RENWICK",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-15",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "13436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naomi L Heinrich, BA
• Robert C Heitz, MHAT
• Dara Jean Helgeson, BS
• Sarah Heller, LPC
• Harmony Clare Lynne Hennings
• Jadee Hesch
• Diane Hibl
• James Hildebrand, CRNA
• Hochhalter Chiropractic, PC
• Hochhalter Physical Therapy

• Psychiatry Physician in Jamestown, ND
• Providers in Jamestown, ND by specialty
• Psychiatry Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; 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.