Active NPI
Mary J Clauson, FNP
- Family Nurse Practitioner
- Atlanta, GA
National Provider Identifier
1871570143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN082935
- Practice address
- 20 Glenlake Parkway
Kaiser Permanente Glenlake
Atlanta, GA 30328 - Phone
- (404) 686-7435
- Fax
- (404) 686-4473
- NPI assigned
- Dec 28, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN082935 | GA | Primary |
| Anesthesiologist Assistant | 367H00000X | 633458 | TX |
Addresses
Primary practice location
20 Glenlake Parkway
Kaiser Permanente Glenlake
Atlanta, GA 30328
Mailing address
3495 Piedmont Road, NE
The Southeast Permanente Medical Group
Atlanta, GA 30305
Phone (404) 551-4948
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 044374901 | Medicaid | TX | |
| 044351705 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 633458 | TX | MD | Anesthesiologist Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesia Consultants of Dallas, LLP | Past | Accepting new patients | |
| Anesthesia Consultants of Dallas LLP | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Anesthesiology Physician
- Dallas, TX
- NPI 1225298516
-
- Anesthesiology Physician
- Dallas, TX
- NPI 1578513768
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290124800000",
"number": "1871570143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3495 PIEDMONT ROAD, NE",
"address_2": "THE SOUTHEAST PERMANENTE MEDICAL GROUP",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30305",
"telephone_number": "404-551-4948",
"fax_number": "404-806-1779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 GLENLAKE PARKWAY",
"address_2": "KAISER PERMANENTE GLENLAKE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30328",
"telephone_number": "404-686-7435",
"fax_number": "404-686-4473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAUSON",
"first_name": "MARY",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-28",
"last_updated": "2010-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN082935",
"primary": true
},
{
"code": "367H00000X",
"taxonomy_group": "",
"desc": "Anesthesiologist Assistant",
"state": "TX",
"license": "633458",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "044374901",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "044351705",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.