Active NPI
Nancy Jeanne Clark, PAC
- Physician Assistant
- Grants Pass, OR
National Provider Identifier
1891714960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA150863
- Practice address
- 500 SW Ramsey Ave
Grants Pass, OR 97527-5554 - Phone
- (541) 472-7000
- NPI assigned
- Jul 19, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA17218 | CA | |
| Physician Assistant | 363A00000X | PA150863 | OR | Primary |
Addresses
Primary practice location
500 SW Ramsey Ave
Grants Pass, OR 97527-5554
Mailing address
825 Bennett Ave
Medford, OR 97504-6715
Phone (541) 779-5228
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17218 | CA | MD | Chiropractor |
| PA17218 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America LLC | Past | Accepting new patients | |
| Cep America LLC | Physician Assistant | 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.
-
- Emergency Medicine Physician
- Roseburg, OR
- NPI 1780647719
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493856000000",
"number": "1891714960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 BENNETT AVE",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975046715",
"telephone_number": "541-779-5228",
"fax_number": "541-772-1533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 SW RAMSEY AVE",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975275554",
"telephone_number": "541-472-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "NANCY",
"middle_name": "JEANNE",
"name_prefix": "Ms.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2017-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA17218",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA150863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.