NPIMap

Individual provider Active NPI

Trisha Clark, PA-C

  • Physician Assistant
  • Tallahassee, FL
National Provider Identifier
1992395974
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2605 Welaunee Blvd
Tallahassee, FL 32308-4697
Phone
(850) 877-8174
NPI assigned
Jan 22, 2021
Last updated
Feb 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA9114106 FL
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2605 Welaunee Blvd
Tallahassee, FL 32308-4697

Mailing address

3334 Capital Medical Blvd Ste 400
Tallahassee, FL 32308-4470
Phone (850) 877-8174

Other practice location 1

3051 6th St
Marianna, FL 32446-1933
Phone (850) 526-3236

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210427002011 FL Practitioner - Physician Assistant 3577971779 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2605 Welaunee Blvd
Tallahassee, FL 32308-4697
Phone (850) 877-8174

3051 6TH St
Marianna, FL 32446-1933
Phone (850) 526-3236

3334 Capital Medical Blvd
Suite 400
Tallahassee, FL 32308-4470
Phone (850) 877-8174

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.5 of 100Reported as group
Quality
69.32
Promoting interoperability
100
Improvement activities
40
Cost
72.03

Merit-based Incentive Payment System (MIPS)

Final score
76.5 of 100Reported as group
Quality
47.27
Promoting interoperability
99
Improvement activities
40
Cost
75.24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9114106FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tallahassee Orthopedic Clinic III PL CurrentSince Jan 13, 2024 Accepting new patients
Tallahassee Orthopedic Clinic III, P.L. CurrentSince Jan 13, 2024 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

3051 6th St
Marianna, FL 32446
Phone (850) 482-0017

2605 Welaunee Blvd
Tallahassee, FL 32308
Phone (850) 219-6100

3334 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 219-1932

3334 Capital Medical Blvd
Ste 400
Tallahassee, FL 32308

Interoperability endpoints

  • Direct secure messaging: trisha.clark.1@18802.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1992395974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 CAPITAL MEDICAL BLVD STE 400",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084470",
            "telephone_number": "850-877-8174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 WELAUNEE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084697",
            "telephone_number": "850-877-8174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3051 6th St",
            "address_purpose": "LOCATION",
            "city": "Marianna",
            "state": "FL",
            "postal_code": "324461933",
            "country_code": "US",
            "telephone_number": "850-526-3236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TRISHA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-22",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9114106",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.