NPIMap

Individual provider Active NPI

Anna E Clark, PA

  • Medical Physician Assistant
  • Mobile, AL
National Provider Identifier
1760519474
Registry record updated Feb 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA514 Issued in AL
Practice address
100 Memorial Hospital Dr
Suite 3a
Mobile, AL 36608-1185
Phone
(251) 342-2641
Fax
(251) 343-9507
NPI assigned
Feb 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA514 AL Primary

Addresses

Primary practice location

100 Memorial Hospital Dr
Suite 3a
Mobile, AL 36608-1185

Mailing address

100 Memorial Hospital Dr
Suite 3a
Mobile, AL 36608-1185
Phone (251) 342-2641

Other identifiers 1

IdentifierTypeStateIssuer
009941968MedicaidAL

Other names 1

  • Anna Evans Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20141022001255 MS Practitioner - Physician Assistant 5294832010 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-3152

833 Hwy 90
Suite 1
Bay St Louis, MS 39520-1601
Phone (228) 575-2920

Hospital & facility affiliations

  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA514ALMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport CurrentSince Jun 25, 2014 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Jun 25, 2014 Accepting new patients

Locations

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

1340 Broad Ave
Ste 320
Gulfport, MS 39501
Phone (228) 575-1775

Interoperability endpoints

  • Direct secure messaging: aclark@direct.mhg.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 and National Provider Directory roles.

Hospital & facility affiliations 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393545600000",
    "number": "1760519474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEMORIAL HOSPITAL DR",
            "address_2": "SUITE 3A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081185",
            "telephone_number": "251-342-2641",
            "fax_number": "251-343-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEMORIAL HOSPITAL DR",
            "address_2": "SUITE 3A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081185",
            "telephone_number": "251-342-2641",
            "fax_number": "251-343-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANNA",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2014-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "PA514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009941968",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNA",
            "last_name": "EVANS",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.