Individual provider Active NPI

Mikaila Ann Turner Clarke, NP

  • Adult Health Nurse Practitioner
  • Worcester, MA
National Provider Identifier
1740336882
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN2275336 Issued in MA
Practice address
100 Grove St Ste 115
Worcester, MA 01605-2630
Phone
(833) 904-0620
NPI assigned
Jan 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 5553 MA
Registered Nurse 163W00000X RN2275336 MA
Adult Health Nurse Practitioner 363LA2200X RN2275336 MA Primary

Addresses

Primary practice location

100 Grove St Ste 115
Worcester, MA 01605-2630

Mailing address

100 Grove St Ste 115
Worcester, MA 01605-2630

Other identifiers 2

IdentifierTypeStateIssuer
1302604MedicaidMA
1301071OtherMAGROUP MEDICAID NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20140313000020 MA Practitioner - Nurse Practitioner 4284864216 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5553MAMDMental Health Counselor
RN2275336MAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cityblock Medical Practice, P.a. CurrentSince Feb 7, 2024 Accepting new patients

Locations

155 Federal St
Ste 700
Boston, MA 02110
Phone (469) 466-7420

100 Grove St
Ste 115
Worcester, MA 01605
Phone (347) 463-5529

495 Flatbush Ave
Brooklyn, NY 11225
Phone 80033611001

55 Water St
#4C
Brooklyn, NY 11201
Phone (917) 718-2063

495 Flatbush Ave
Ste C5
Brooklyn, NY 11225
Phone (215) 588-1676

Interoperability endpoints

  • Direct secure messaging: mikaila.turner-.clarke.1@27775.direct.athenahealth.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1740336882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GROVE ST STE 115",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GROVE ST STE 115",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052630",
            "telephone_number": "833-904-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TURNER CLARKE",
        "first_name": "MIKAILA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "5553",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "RN2275336",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN2275336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1302604",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID NUMBER",
            "identifier": "1301071",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.