Calvin Clarke

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP60498791 Issued in WA

Practice address

11019 Canyon Rd E Ste a
Puyallup, WA 98373-3001

Phone

(253) 537-0293

Fax

(253) 537-7650

NPI assigned

Oct 1, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services - Washington 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Assured Home Health and Hospice Home health agency, Centralia, WA, CCN 507042
• Harbors Home Health / Hospice Home health agency, Hoquiam, WA, CCN 507020
• Providence at Home With Compassus, Puget Sound South Home health agency, Lacey, WA, CCN 507004
• Providence Centralia Hospital Hospital, Centralia, WA, CCN 500019
• Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cclarke2037678@wm.providencedirect.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.

• Providence Health & Services - Washington

  • Rural Health Clinic/Center
  • Rochester, WA
  • NPI 1205931508

  WA

  Medicare reassignment Care Compare group NPD
• Providence Health & Services Washington

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1174744304

  WA

  Medicare reassignment NPD
• Providence Health & Services Washington

  • General Practice Physician
  • Olympia, WA
  • NPI 1134656135
  NPD

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

• CP Sound Wa, LLC

  • Home Health Agency
  • Lacey, WA
  • NPI 1669294708
  Care Compare affiliation
• Harbors Home Health & Hospice

  • Home Health Agency
  • Hoquiam, WA
  • NPI 1699777276
  Care Compare affiliation
• Northwest Healthcare Alliance, Inc.

  • Home Health Agency
  • Centralia, WA
  • NPI 1154397305
  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1346250594

  Hospital

  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Centralia, WA
  • NPI 1376624981

  Hospital

  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1619176997

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1443657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1851761027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "253-537-0293",
            "fax_number": "253-537-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11019 CANYON RD E STE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733001",
            "telephone_number": "253-537-0293",
            "fax_number": "253-537-7650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 E Main",
            "address_2": "Suite 302",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983726779",
            "country_code": "US",
            "telephone_number": "253-841-2471",
            "fax_number": "253-841-2472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "CALVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-01",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60498791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clara W Brannan DDS, PS
• Dale D Clark
• Howard Sherman Clark, M.D.
• Jessica Ashley Clark, MA
• Kim M. Clark
• Christiane S Clarke
• Joshua David Clarke, PT
• Megan Clarno, PAC
• Heidi A Clay, MD
• Nicholas Clayville, PHARMD

• All providers in Puyallup, WA
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.
• 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.