Shantera Clark, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN220889 Issued in GA

Practice address

630 Ogeechee Dr W
Statesboro, GA 30461-6753

Phone

(478) 456-0238

NPI assigned

Jul 6, 2020

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 GA

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group of Georgia LLCGroup PAC ID 4284951542, 454 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
• Direct secure messaging: shantera.clark.1@8042.direct.athenahealth.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.

• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857

  GA

  Medicare reassignment Care Compare group NPD
• Christopher Dennis MD PLLC

  • Psychiatry Physician
  • Johns Creek, GA
  • NPI 1588090229

  GA

  Medicare reassignment NPD
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1356907273
  Care Compare group NPD

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

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1962020057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1964",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304591964",
            "telephone_number": "478-456-0238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 OGEECHEE DR W",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304616753",
            "telephone_number": "478-456-0238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANTERA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-06",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN220889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Taylor Clark, M.D.
• Adam Wyatt Clark, PHARM.D
• Gayle Chappell Clark, R.PH
• Iris Kalin Clark, M.D.
• Michael Ryan Clark, PHARMD
• Skyler Clark
• Taylor Victoria Clark
• Shelly Clary, FNP-BC
• Heather Cleary, LPC
• Clemons Family Practice, Inc.

• All providers in Statesboro, GA
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.