Anna Lisa Clark, LISW, LICDC is a medicare enrolled "Counselor - Addiction (substance Use Disorder)" provider in North Ridgeville, Ohio. Her current practice location is
35888 Center Ridge Rd, Suite 5, North Ridgeville, Ohio. You can reach out to her office (for appointments etc.) via phone at
(440) 327-1800.
Anna Lisa Clark is licensed to practice in Ohio (license number 862262) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1457376485.
Healthcare Provider's Profile
| Full Name | Anna Lisa Clark |
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| Gender | Female |
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| Speciality | Counselor - Addiction (substance Use Disorder) |
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| Location | 35888 Center Ridge Rd, North Ridgeville, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1457376485
- Provider Enumeration Date: 07/12/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 4284690728
- Enrollment ID: I20140131000587
Medical Identifiers
Medical identifiers for Anna Lisa Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1457376485 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1041C0700X | Social Worker - Clinical | I-0007941 (Ohio) | Primary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 862262 (Ohio) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Anna Lisa Clark allows following entities to bill medicare on her behalf.
| Entity Name | Sondermind Provider Network Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1760854442
PECOS PAC ID: 9537572490
Enrollment ID: O20210316002509 |
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| Entity Name | Autumn Treatment Center Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1225601826
PECOS PAC ID: 6002204344
Enrollment ID: O20211019002513 |
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| Entity Name | Grow Healthcare Group Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1245845932
PECOS PAC ID: 3476961368
Enrollment ID: O20220604000326 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Anna Lisa Clark is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Anna Lisa Clark, LISW, LICDC
35888 Center Ridge Rd, Suite 5,
North Ridgeville, OH 44039-3086
Ph: (440) 327-1800 | Anna Lisa Clark, LISW, LICDC
35888 Center Ridge Rd, Suite 5,
North Ridgeville, OH 44039-3086
Ph: (440) 327-1800 |
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