Active NPI
Teralea M Clark
- Hearing Instrument Specialist
- Lake Worth, FL
National Provider Identifier
1760589550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hearing Instrument Specialist
- License
- AS2652
- Practice address
- 7701 Lake Worth Rd
Lake Worth, FL 33467-2536 - Phone
- (561) 439-8821
- Fax
- (561) 439-5035
- NPI assigned
- Sep 20, 2006
- Last updated
- Oct 15, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hearing Instrument Specialist | 237700000X | AS2652 | FL | Primary |
Addresses
Primary practice location
7701 Lake Worth Rd
Lake Worth, FL 33467-2536
Mailing address
PO Box 406153
Atlanta, GA 30384-1876
Phone (561) 478-8770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 610124100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AS2652 | FL | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hearusa Inc | Past | Accepting new patients | |
| Audiology Distribution, LLC | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 2
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.
-
- Audiologist-Hearing Aid Fitter
- West Palm Beach, FL
- NPI 1073560231
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224028800000",
"number": "1760589550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 406153",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303841876",
"telephone_number": "561-478-8770",
"fax_number": "561-688-8877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7701 LAKE WORTH RD",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334672536",
"telephone_number": "561-439-8821",
"fax_number": "561-439-5035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TERALEA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2008-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "237700000X",
"taxonomy_group": "",
"desc": "Hearing Instrument Specialist",
"state": "FL",
"license": "AS2652",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "610124100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.