Kimberly Nicole Clark, MMS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.007399 Issued in IL

Practice address

1600 N Randall Rd Ste 400
Elgin, IL 60123-7805

Phone

(847) 381-8899

NPI assigned

Nov 20, 2019

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Derick Dermatology PLLCGroup PAC ID 1557366796, 65 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kclark@directaddress.net

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.

• Derick Dermatology, PLLC

  • Dermatology Physician
  • Crystal Lake, IL
  • NPI 1134664402
  Medicare reassignment Care Compare group
• Derick Dermatology, PLLC

  • Dermatology Physician
  • Bartlett, IL
  • NPI 1225526627
  NPD
• Derick Dermatology, PLLC

  • Dermatology Physician
  • Tampa, FL
  • NPI 1396455861
  NPD
• Derick Dermatology, PLLC

  • Dermatology Physician
  • Arlington Heights, IL
  • NPI 1497792618
  NPD (past)

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1720624166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "0N331 ETHEL ST",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601901051",
            "telephone_number": "630-890-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N RANDALL RD STE 400",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601237805",
            "telephone_number": "847-381-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "credential": "MMS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-20",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.007399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kclark@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Derick Dermatology",
            "address_1": "1600 N Randall Rd Ste 400",
            "city": "Elgin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601237805",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://select.nextech-api.com/api",
            "affiliation": "N",
            "endpointDescription": "Derick Dermatology",
            "address_1": "1600 N Randall Rd Ste 400",
            "city": "Elgin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601237805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cindy R Rauschenberger DDS Ms LTD
• Citadel Care Center-Elgin, LLC
• City of Elgin
• Clarity of Mind Counseling, Inc.
• Clarity, Calm & Peace Behavioral Health Services, Inc.
• Jasmoniqua Cleveland
• Kelli Clevenger, PT
• Patricia Cline, LCSW
• Beth A Clingan, DO
• Clinica Su Red Elgin LLC

• Physician Assistant in Elgin, IL
• Providers in Elgin, IL by specialty
• Physician Assistant in Illinois

• 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.