Nicole Renae Clark, LICSW in Birmingham, AL - Medicare Social Worker Provider

Nicole Renae Clark, LICSW is a medicare enrolled "Social Worker - Clinical" provider in Birmingham, Alabama. Her current practice location is 48 Medical Park Dr E, Birmingham, Alabama. You can reach out to her office (for appointments etc.) via phone at (205) 517-7730.

Nicole Renae Clark is licensed to practice in Alabama (license number 3619C) 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 1841927415.

Contact Information

	Nicole Renae Clark, LICSW
	48 Medical Park Dr E, Birmingham, AL 35235-3400
	(205) 517-7730
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Nicole Renae Clark
Gender	Female
Speciality	Social Worker - Clinical
Location	48 Medical Park Dr E, Birmingham, Alabama
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1841927415
Provider Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022

Medicare PECOS Information:

PECOS PAC ID: 2769867357
Enrollment ID: I20220919000376

Medical Identifiers

Medical identifiers for Nicole Renae Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1841927415	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1041C0700X	Social Worker - Clinical	3619C (Alabama)	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. Nicole Renae Clark allows following entities to bill medicare on her behalf.

Entity Name	Impact Behavioral Counseling Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1386169050 PECOS PAC ID: 1355604836 Enrollment ID: O20180622002111

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. Nicole Renae 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
Nicole Renae Clark, LICSW 600 27th Ave Nw, Center Point, AL 35215-2216 Ph: (205) 482-2739	Nicole Renae Clark, LICSW 48 Medical Park Dr E, Birmingham, AL 35235-3400 Ph: (205) 517-7730

Reviews and Comments

Social Worker in Birmingham, AL

Tara L Foley, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3600 7th Ct S Ste 100, Birmingham, AL 35222 Phone: 205-945-7483 Fax: 205-945-7083
Page Rubin, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 300 Century Park S Bldg 300, Birmingham, AL 35226 Phone: 205-942-3200
Christa Devaughn Brown, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3220 5th Ave S Ste 100, Birmingham, AL 35222 Phone: 205-877-8677 Fax: 205-877-8675
Amy Daniel Pribyl, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 619 19th Street South, Birmingham, AL 35233 Phone: 205-934-6600
Muriel C. Thompson, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1037 22nd Street South, Suite 200, Birmingham, AL 35205 Phone: 205-326-1513 Fax: 205-326-1514
Mrs. Dorinda A Smith, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 129 E Park Cir, Birmingham, AL 35235 Phone: 205-836-7283 Fax: 205-836-9594
Melissa Evans, Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 700 19th St S, Birmingham, AL 35233 Phone: 205-369-0865

Nicole Renae Clark, LICSW - Medicare Clinical Social Worker in Birmingham, AL