NPIMap

Individual provider Active NPI

Caitlin Marie Clark, FNP

  • Family Nurse Practitioner
  • Durham, NC
National Provider Identifier
1790380988
Registry record updated Mar 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5013848 Issued in NC
Practice address
234 Crooked Creek Pkwy Ste 200
Durham, NC 27713-8506
Phone
(919) 544-6644
NPI assigned
Dec 3, 2020
Last updated
Mar 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5013848 NC Primary

Addresses

Primary practice location

234 Crooked Creek Pkwy Ste 200
Durham, NC 27713-8506

Mailing address

6016 Kayton St
Raleigh, NC 27616-4328
Phone (512) 364-4081

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20210405000786 NC Practitioner - Nurse Practitioner 6103233408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

10211 Alm St
Raleigh, NC 27617-8221
Phone (919) 206-4889

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5013848NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. Internal Medicine CurrentSince Mar 8, 2021 Accepting new patients
Duke University Affiliated Physicians, Inc Internal Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. Internal Medicine CurrentSince Mar 8, 2021 Accepting new patients

Locations

234 Crooked Creek Pkwy
Ste 200
Durham, NC 27713
Phone (919) 213-6631

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

6020 Fayetteville Rd
Durham, NC 27713
Phone (919) 572-2000

10211 Alm St
Raleigh, NC 27617
Phone (919) 206-4868

Interoperability endpoints

  • Direct secure messaging: cboykin257909@direct.medicine.duke.edu

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1790380988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6016 KAYTON ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276164328",
            "telephone_number": "512-364-4081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 CROOKED CREEK PKWY STE 200",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277138506",
            "telephone_number": "919-544-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAITLIN",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-03",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5013848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.