Shanta Lynn Clark, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007413 Issued in MI

Practice address

58620 Sink Rd
Pokagon Health Services
Dowagiac, MI 49047-9329

Phone

(269) 782-4141

NPI assigned

Jul 10, 2015

Last updated

Jul 10, 2015By the provider in NPPES

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 TX

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

Merit-based Incentive Payment System (MIPS)

Final score

67.89 of 100Reported as group

Quality

100

Promoting interoperability

0

Improvement activities

40

Cost

76.31

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Pokagon Band of Potawatomi Indians

  dba Pokagon Health Service

  • Federally Qualified Health Center (FQHC)
  • Dowagiac, MI
  • NPI 1497833271

  TX

  Medicare reassignment
• Pokagon Band of Potawatomi Indians

  dba Mshkiki Community Clinic Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Benton Harbor, MI
  • NPI 1790594349
  NPD (past)

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

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1790169688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58620 SINK RD",
            "address_2": "POKAGON HEALTH SERVICES",
            "city": "DOWAGIAC",
            "state": "MI",
            "postal_code": "490479329",
            "telephone_number": "269-782-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58620 SINK RD",
            "address_2": "POKAGON HEALTH SERVICES",
            "city": "DOWAGIAC",
            "state": "MI",
            "postal_code": "490479329",
            "telephone_number": "269-782-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANTA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-10",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Burau, D.M.D.
• Charles Kenneth Burling, DDS
• Linda Strickler Campbell, GNP
• Eric J Chamberlin, MSW
• Boonchoo Chang, M.D.
• Michelle Marie Cockey, FNP
• Delphine Colar, DO
• Comfort Living Home L.L.C. #3
• Community Care of Dowagiac, PLLC
• Heather Cook-Sinden, NP

• Physician Assistant in Dowagiac, MI
• Providers in Dowagiac, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.