Kelsey Nicole Clark, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

25MB12242400 Issued in NJ

Practice address

651 Willow Grove St
Hackettstown, NJ 07840-1799

Phone

(908) 852-5100

NPI assigned

Mar 29, 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 NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

West Virginia School of Osteopathic Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Newton Emergency Medical Associates LLCGroup PAC ID 3678735057, 31 clinicians

Hackettstown Emergency Medical Associates, LLCGroup PAC ID 4688998990, 22 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Newton Medical Center Hospital, Newton, NJ, CCN 310028
• Ahs Hospital Corp Hospital, Hackettstown, NJ, CCN 310115

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Hackettstown Emergency Medical Associates LLC

  • Emergency Medicine Physician
  • Hackettstown, NJ
  • NPI 1558768473
  Medicare reassignment Care Compare group NPD
• Newton Emergency Medical Associates LLC

  • Emergency Medicine Physician
  • Newton, NJ
  • NPI 1306118344
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ahs Hospital Corp

  • General Acute Care Hospital
  • Hackettstown, NJ
  • NPI 1518969419
  Care Compare affiliation
• Ahs Hospital Corp

  • General Acute Care Hospital
  • Newton, NJ
  • NPI 1790789212
  Care Compare affiliation

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723852800000",
    "number": "1962080390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 CENTURY DR",
            "city": "PARSIPPANY",
            "state": "NJ",
            "postal_code": "070544610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 WILLOW GROVE ST",
            "city": "HACKETTSTOWN",
            "state": "NJ",
            "postal_code": "078401799",
            "telephone_number": "908-852-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELSEY",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2024-08-17",
        "certification_date": "2024-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MB12242400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christus Institute for Family Life, LLC
• Jagdish C Chugh
• Jessica Cianci, PHARMD
• Thomas P Cichon II
• Ewa Ciecierega, DMD
• Claude J Abbondante DPM
• Taylor Clawson
• Richard James Cleave III, D.M.D.
• Clinton Avenue Community Care Center PC
• Laurene Lynn Clossey, PHD

• Emergency Medicine Physician in Hackettstown, NJ
• Providers in Hackettstown, NJ by specialty
• Emergency Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2024; 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.