Courtney A Clark, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704253017 Issued in MI

Practice address

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Phone

(248) 898-5000

NPI assigned

Jan 6, 2011

Last updated

Apr 5, 2013By 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

Other names 1

• Courtney A Smith Former name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Anesthesia Resources, Inc.Group PAC ID 3476455726, 14 clinicians

Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Henry Ford West Bloomfield HospitalGroup PAC ID 2264589449, 83 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health West Bloomfield Hospital Hospital, W Bloomfield, MI, CCN 230302

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cclark704638@direct.hfhs.org

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.

• Henry Ford Health System

  • Certified Registered Nurse Anesthetist
  • Detroit, MI
  • NPI 1871666479

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Henry Ford West Bloomfield Hospital

  • Anesthesiology Physician
  • West Bloomfield, MI
  • NPI 1518104686

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Midwest Anesthesia Resources, Inc.

  • Certified Registered Nurse Anesthetist
  • Northville, MI
  • NPI 1467424465

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Asa Staffing Inc

  • Certified Registered Nurse Anesthetist
  • Rochester, MI
  • NPI 1114378981

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Paragon Anesthesia PLLC

  • Anesthesiology Physician
  • Birmingham, MI
  • NPI 1356940670
  Medicare reassignment NPD
• Superior Anesthetists Associates, Inc.

  • Specialist
  • Troy, MI
  • NPI 1831144518
  Medicare reassignment NPD
• William Beaumont Hospital

  • Hospitalist Physician
  • Royal Oak, MI
  • NPI 1811044878

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Environ Anesthesia, LLC.

  • Anesthesiology Physician
  • Lexington, KY
  • NPI 1831438092

  MI, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Northstar Anesthesia of Michigan III PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Irving, TX
  • NPI 1972126209

  MI, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD
• Henry Ford West Bloomfield Hospital

  dba Henry Ford West Bloomfield-Employed Physicians

  • Internal Medicine Physician
  • West Bloomfield, MI
  • NPI 1386920122
  NPD
• William Beaumont Hospital

  dba Beaumont Hospital, Grosse Pointe

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  NPD

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

• Henry Ford Health System

  dba Henry Ford West Bloomfield Hospital

  • General Acute Care Hospital
  • West Bloomfield, MI
  • NPI 1407867559
  Care Compare affiliation

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365120000000",
    "number": "1851695753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "COURTNEY",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-06",
        "last_updated": "2013-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704253017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "SMITH",
            "middle_name": "A",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Courtney Leigh Ciullo, NP-C
• CKG Psych Inc
• Claire Peeples, MD, PLLC (Claire Peeples, M.D.)
• Carly Peyton Clark, M.A., CF-SLP
• Carol Clark
• Donald Clark, LMSW
• Ekaterina Lavroushina Clark, MD
• Margaret E. Clark, NP
• Susan M Clark, MA LLP
• Tierra Clark

• Certified Registered Nurse Anesthetist in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.