Kelly Clark, APRN-CNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN-CNP.0029273 Issued in OH

Practice address

667 Converse Dr
Cincinnati, OH 45240-3619

Phone

(513) 967-5315

NPI assigned

Aug 2, 2021

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

Medicare fee-for-service enrollment

Enrolled in OH

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eon Care Services LLCGroup PAC ID 8820529704, 20 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.57 of 100Reported as group

Quality

58.53

Promoting interoperability

100

Improvement activities

40

Cost

86.71

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Eon Care Services, LLC

  • Nurse Practitioner
  • Germantown, MD
  • NPI 1508613886

  OH

  Medicare reassignment Care Compare group NPD
• Mobile Medical Inc

  dba OnSight Health Care

  • Optometrist
  • Perrysburg, OH
  • NPI 1689620015
  Medicare reassignment NPD
• Nurse Practitioner Group LLC

  • Contractor
  • Plantation, FL
  • NPI 1780121277

  OH

  Medicare reassignment NPD
• Mobile Medical, Inc.

  dba Onsight Health Care

  • Dentist
  • Perrysburg, OH
  • NPI 1629228572
  NPD
• Mobile Medical, Inc.

  • Podiatrist
  • Perrysburg, OH
  • NPI 1003066747
  NPD (past)

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1902579238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "667 CONVERSE DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452403619",
            "telephone_number": "513-967-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "667 CONVERSE DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452403619",
            "telephone_number": "513-967-5315"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4400 Easton Cmns Ste 125",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432196223",
            "country_code": "US",
            "telephone_number": "574-546-1900",
            "fax_number": "574-546-1999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-02",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN-CNP.0029273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jensine Juanita Clark
• Jesse L Clark
• Joshua Michael Clark, MD
• Katherine Elizabeth Clark, M.D.
• Keith Terrill Clark, M.D.
• Kennedy Michele Clark
• Kristal D Clark, CNP
• Kristen Clark, M.S. CCC-SLP
• Krystal Clark
• Larissa Maria Clark, PHARMD

• Gerontology Nurse Practitioner in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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.