Melissa Clark, 6002172

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34005724A Issued in IN

Practice address

6141 Basswood Dr
Columbus, IN 47201-8431

Phone

(812) 603-6827

NPI assigned

Nov 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

State University of New York at Buffalo School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Saint Peter'S Lutheran ChurchGroup PAC ID 8224579818, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Saint Peter'S Lutheran Church

  • Voluntary or Charitable Agency
  • Columbus, IN
  • NPI 1477800373
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459296000000",
    "number": "1801967195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 5TH ST",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472016306",
            "telephone_number": "812-372-1571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6141 BASSWOOD DR",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472018431",
            "telephone_number": "812-603-6827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MELISSA",
        "credential": "6002172",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-10",
        "last_updated": "2016-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C003571",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005724A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002172",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CHS Indiana LLC
• Sheryl Wen Jing Chua, DPT
• City Optical Co., Inc.
• Gabreille Civiletto, RBT
• Brittany Nicole Clark
• Mollie Clark, RBT
• Roy Ellis Clark, M.S., CCC-A
• Shelley L Clark, NP
• Taylor Clark, RBT
• Stacey Ann Claycamp

• Clinical Social Worker in Columbus, IN
• Providers in Columbus, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; 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.