Erin Noelle Clark

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

202101839NP-PP Issued in OR

Practice address

495 SW Ramsey Ave
Grants Pass, OR 97527-5681

Phone

(541) 476-6644

NPI assigned

Feb 26, 2021

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

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: erinclark@gpc.allscriptsdirect.net
• Direct secure messaging: erinclark@grantspass.allscriptsdirect.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.

• Grants Pass Clinic LLP

  • Internal Medicine Physician
  • Grants Pass, OR
  • NPI 1760418032
  Medicare reassignment NPD

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

{
    "created_epoch": "1614297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1770177941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 WESTWOOD DR",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975277231",
            "telephone_number": "541-660-0169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 SW RAMSEY AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275681",
            "telephone_number": "541-476-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ERIN",
        "middle_name": "NOELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-26",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OR",
            "license": "202101839NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Robert Cielinski
• Justin Cirillo, LMT
• Jessi Marie Claassen
• Angela Kate Clark
• Dennis Ray Clark, R.PH.
• Graeme Jessen Clark, LMT
• Kristen Clark, MS, ATC
• Lorraine Dannia Clark
• Nancy Jeanne Clark, PAC
• Sean Clark

• Pediatric Nurse Practitioner in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Pediatric Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.