NPIMap

Individual provider Active NPI

Brooke Clark, CRNP

  • Family Nurse Practitioner
  • Ephrata, PA
National Provider Identifier
1720703085
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP026333 Issued in PA
Practice address
4131A Oregon Pike
Ephrata, PA 17522-9550
Phone
(717) 859-1123
Fax
(717) 859-2898
NPI assigned
Oct 10, 2022
Last updated
Dec 29, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP026333 PA Primary

Addresses

Primary practice location

4131A Oregon Pike
Ephrata, PA 17522-9550

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 859-1123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221028000113 PA Practitioner - Nurse Practitioner 7012384472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

101 Fairview Cir
Lebanon, PA 17042-9581
Phone (717) 279-7303

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Oct 24, 2022 Accepting new patients
Wellspan Medical Group Current Accepting new patients
Wellspan Medical Group CurrentSince Oct 24, 2022 Accepting new patients

Locations

4131A Oregon Pike
Ephrata, PA 17522
Phone (717) 859-1123

101 Fairview Cir
North Cornwall, PA 17042
Phone (717) 279-7303

1600 S George St
York, PA 17403
Phone (717) 848-3615

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

Interoperability endpoints

  • Direct secure messaging: bclark18174@wellspan.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1720703085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-859-1123",
            "fax_number": "717-859-2898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131A OREGON PIKE",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175229550",
            "telephone_number": "717-859-1123",
            "fax_number": "717-859-2898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BROOKE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-10",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP026333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ephrata, PA

Sources for this page

Verify at the official NPI Registry.