NPIMap

Individual provider Active NPI

Nancy L Clark, PA-C

  • Medical Physician Assistant
  • Bellevue, WA
National Provider Identifier
1831230911
Registry record updated Sep 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA10003692 Issued in WA
Practice address
13033 Bellevue Redmond Rd
#110
Bellevue, WA 98005-2633
Phone
(425) 468-6500
Fax
(425) 468-6501
NPI assigned
Feb 9, 2007
Last updated
Sep 15, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA10003692 WA Primary

Addresses

Primary practice location

13033 Bellevue Redmond Rd
#110
Bellevue, WA 98005-2633

Mailing address

13033 Bellevue Redmond Rd
#110
Bellevue, WA 98005-2633
Phone (425) 468-6500

Other identifiers 1

IdentifierTypeStateIssuer
171527OtherWALABOR AND INDUSTRIES

Other names 1

  • Nancy L Heaverlo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20150821013630 WA Practitioner - Physician Assistant 6406972686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11245 State Route 525
Clinton, WA 98236-8638
Phone (360) 341-5252

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
832AKMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
WGH Primary Care Associates, P.S. Current Accepting new patients
Whidbey Island Public Hospital District CurrentSince Jul 6, 2015 Accepting new patients
Whidbey Island Public Hospital District CurrentSince Jul 6, 2015 Accepting new patients
Whidbey Island Public Hospital District Past Accepting new patients
Public Hospital District No 2 Skagit County Washington Past Accepting new patients
U.S. Healthworks Medical Group of Washington, PS Past Accepting new patients
Healthforce Occupational Medicine Past Accepting new patients

Locations

11245 State Route 525
Clinton, WA 98236
Phone (360) 341-5252

101 N Main St
Coupeville, WA 98239
Phone (360) 678-7656

5486 Harbor Ave
Freeland, WA 98249
Phone (360) 331-5060

275 SE Cabot Dr
Ste B101
Oak Harbor, WA 98277
Phone (360) 675-6648

Organizations & group practices 8

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 6

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": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221436800000",
    "number": "1831230911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13033 BELLEVUE REDMOND RD",
            "address_2": "#110",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980052633",
            "telephone_number": "425-468-6500",
            "fax_number": "425-468-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13033 BELLEVUE REDMOND RD",
            "address_2": "#110",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980052633",
            "telephone_number": "425-468-6500",
            "fax_number": "425-468-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NANCY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2008-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "171527",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANCY",
            "last_name": "HEAVERLO",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.