Individual provider Active NPI

Matthew Howard Clardy, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bloomington, IN
National Provider Identifier
1962282509
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
71014387A Issued in IN
Practice address
3600 N Prow Rd
Bloomington, IN 47404-1616
Phone
(812) 331-8000
NPI assigned
Oct 2, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71014387A IN Primary

Addresses

Primary practice location

3600 N Prow Rd
Bloomington, IN 47404-1616

Mailing address

3231 N Obrien PL
Bloomington, IN 47404-1729
Phone (812) 325-1152

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20231019000580 IN Practitioner - Nurse Practitioner 3375999865 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bloomington Meadows GP CurrentSince Sep 13, 2023 Accepting new patients

Locations

3600 N Prow Rd
Bloomington, IN 47404
Phone (812) 331-8000

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1696204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1962282509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 N OBRIEN PL",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474041729",
            "telephone_number": "812-325-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 N PROW RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474041616",
            "telephone_number": "812-331-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARDY",
        "first_name": "MATTHEW",
        "middle_name": "HOWARD",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-02",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71014387A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.