Lisa Diane Clark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

200550098 Issued in OR

Practice address

265 N Broadway St
Portland, OR 97227-1800

Phone

(503) 274-4885

Fax

(503) 274-4814

NPI assigned

Feb 27, 2006

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northwest Cancer Specialists PCGroup PAC ID 8426943838, 70 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lisa.clark@compass.ikm.direct-ci.com

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.

• Northwest Cancer Specialists PC

  • Hematology & Oncology Physician
  • Vancouver, WA
  • NPI 1407828114

  OR

  Medicare reassignment Care Compare group
• Northwest Cancer Specialists, PC

  • Clinical Medical Laboratory
  • Vancouver, WA
  • NPI 1548506587
  NPD

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1942276282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 N BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271800",
            "telephone_number": "503-274-4885",
            "fax_number": "503-274-4814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 N BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271800",
            "telephone_number": "503-274-4885",
            "fax_number": "503-274-4814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LISA",
        "middle_name": "DIANE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-27",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "200550098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273968",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022791",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kendall Olivia Clark
• Kim M Clark, O.D.
• Kylie Clark, M.D.
• Leonard Clark, CERTIFIED ALCOHOL &
• Liberty Sky Clark
• Louise Clark, MD
• Madeline Julia Clark, BCBA
• Mandy Clark
• Marco Clark
• Mariko Fukuyama Clark, LMHC

• Family Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; 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.