Tiffany A Clark, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12149 Issued in MN

Practice address

404 W Fountain St
Albert Lea, MN 56007-2437

Phone

(507) 373-2384

NPI assigned

Jun 13, 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

Other names 1

• Tiffany C Hirsch Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tiffany.clark.p1@direct.scihp.nextgenshare.com
• Direct secure messaging: tclark810378@direct.ochin.org

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.

• Northeastern Rural Health Clinics

  • Family Medicine Physician
  • Susanville, CA
  • NPI 1477563518
  Medicare reassignment NPD
• California Em-I Medical Services

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1649229600

  Physician Assistant

  NPD (past)
• Centinela Freeman Emergency Medical Associates

  • Emergency Medicine Physician
  • Inglewood, CA
  • NPI 1962539684
  NPD (past)
• Convenientmd LLC

  • Urgent Care Clinic/Center
  • Newburyport, MA
  • NPI 1316428824
  NPD (past)
• Ideal Spine & Rehab

  • Chiropractor
  • Tustin, CA
  • NPI 1205128949
  NPD (past)

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1831132406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W FOUNTAIN ST",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560072437",
            "telephone_number": "507-377-6285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W FOUNTAIN ST",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560072437",
            "telephone_number": "507-373-2384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIFFANY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16777",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA16777",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tiffanyclark@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1230 E Main St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560015066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "HIRSCH",
            "middle_name": "C",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Larissa Chapman, RDN
• Mary A Christensen, M.D.
• Kay Joann Christianson, RN
• Mark Robert Ciota, M.D.
• Curt Clarambeau, RPH
• Sandra Diane Clawson, RN CNP
• Sandra E Clover, RN
• Cara C Cockerill, MD
• Nancy Joyce Cooper-Cope, PHARMD
• Daniel Maurice Cottrell, O.D.

• Physician Assistant in Albert Lea, MN
• Providers in Albert Lea, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; 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.