Courtney A Clark, DO is a medicare enrolled "Pediatrics" physician in Picayune, Mississippi. Her current practice location is
2274 Highway 43 S, Picayune, Mississippi. You can reach out to her office (for appointments etc.) via phone at
(601) 347-9024.
Courtney A Clark is licensed to practice in Mississippi (license number 29407) 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 1790100113.
Physician's Profile
Full Name | Courtney A Clark |
---|
Gender | Female |
---|
Speciality | Pediatrics |
---|
Location | 2274 Highway 43 S, Picayune, Mississippi |
---|
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1790100113
- Provider Enumeration Date: 02/21/2014
- Last Update Date: 11/15/2021
Medicare PECOS Information:
- PECOS PAC ID: 4284023821
- Enrollment ID: I20211119000917
Medical Identifiers
Medical identifiers for Courtney A Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1790100113 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208000000X | Pediatrics | 1790100113 (Virginia) | Secondary |
208000000X | Pediatrics | 29407 (Mississippi) | 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. Courtney A Clark allows following entities to bill medicare on her behalf.
Entity Name | Ochsner Mississippi, Llc |
---|
Entity Type | Part B Supplier - Clinic/group Practice |
---|
Entity Identifiers | NPI Number: 1538674239 PECOS PAC ID: 0143580993 Enrollment ID: O20180216000366 |
---|
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. Courtney A 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 |
Courtney A Clark, DO 1514 Jefferson Hwy, New Orleans, LA 70121-2429 Ph: (504) 842-4000 | Courtney A Clark, DO 2274 Highway 43 S, Picayune, MS 39466-8141 Ph: (601) 347-9024 |
Reviews and Comments