Heather Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0005635 Issued in MD

Practice address

9815 Main St Ste 208
Damascus, MD 20872

Phone

(301) 253-4004

Fax

(301) 253-3391

NPI assigned

Nov 25, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Heather Stultz Former name

Medicare fee-for-service enrollment

Enrolled in MD, DC2 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

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Suburban/NRH Medical Rehabilitation IncGroup PAC ID 6507846771, 885 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Home Health Services, Inc. Home health agency, Silver Spring, MD, CCN 217032

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bowie, MD
  • NPI 1093130924

  DC

  Medicare reassignment NPD
• Sinai Hospital of Baltimore Inc

  • Surgical Critical Care Physician
  • Baltimore, MD
  • NPI 1043235666
  Medicare reassignment
• Suburban/NRH Medical Rehabilitation Inc

  • Rehabilitation Clinic/Center
  • Bethesda, MD
  • NPI 1457354748
  Care Compare group
• MNR Industries LLC

  • Urgent Care Clinic/Center
  • Mount Airy, MD
  • NPI 1073963146
  NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Westminster, MD
  • NPI 1093042012
  NPD
• MNR Industries, LLC

  • Urgent Care Clinic/Center
  • Bel Air, MD
  • NPI 1649089418
  NPD
• Sinai Hospital of Baltimore Inc

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1255359782
  NPD
• Sinai Hospital of Baltimore, Inc.

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1285672204
  NPD
• Dr. Benjamin F. Papoi, P.C.

  • Family Medicine Physician
  • Damascus, MD
  • NPI 1740212893
  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

• Adventist Home Health Services Inc

  • Home Health Agency
  • Silver Spring, MD
  • NPI 1598826448
  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1972900520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9815 MAIN ST STE 208",
            "city": "DAMASCUS",
            "state": "MD",
            "postal_code": "208722099",
            "telephone_number": "301-253-4004",
            "fax_number": "301-253-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9815 MAIN ST STE 208",
            "city": "DAMASCUS",
            "state": "MD",
            "postal_code": "20872",
            "telephone_number": "301-253-4004",
            "fax_number": "301-253-3391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "504 E Ridgeville Blvd",
            "address_purpose": "LOCATION",
            "city": "Mount Airy",
            "state": "MD",
            "postal_code": "21771",
            "country_code": "US",
            "telephone_number": "301-703-5452",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1415 Mountain Road",
            "address_purpose": "LOCATION",
            "city": "Joppa",
            "state": "MD",
            "postal_code": "21085",
            "country_code": "US",
            "telephone_number": "410-918-0777",
            "fax_number": "410-369-1701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "HEATHER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-25",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "C0005635",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0005635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "STULTZ",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather Blanchard
• Karen Gayman Brindle, CNM, MSN
• Idette Brumbaugh, RN
• Jerri Cacopardo
• Brittany Chwastiak
• Anna Connolly, M. A., CCC-SLP
• Kathleen Cozdeba-Dehn, RN
• Katey Lynn Cressy, PAC
• Craig Stephen Cropp, M.D.
• Dal Dermatology, Inc.

• Physician Assistant in Damascus, MD
• Providers in Damascus, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; 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.