Erin Olivia Clark, is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Fayetteville, North Carolina. Her current practice location is
1601 Owen Dr, Fayetteville, North Carolina. You can reach out to her office (for appointments etc.) via phone at
(910) 678-0100.
Erin Olivia Clark is licensed to practice in * (Not Available) (license number ) 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 1134680325.
Physician's Profile
| Full Name | Erin Olivia Clark |
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| Gender | Female |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 1601 Owen Dr, Fayetteville, North Carolina |
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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: 1134680325
- Provider Enumeration Date: 03/29/2019
- Last Update Date: 08/22/2021
Medicare PECOS Information:
- PECOS PAC ID: 4587997747
- Enrollment ID: I20220506000420
Medical Identifiers
Medical identifiers for Erin Olivia Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1134680325 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208D00000X | General Practice | 2021-02324 (North Carolina) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | 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. Erin Olivia Clark allows following entities to bill medicare on her behalf.
| Entity Name | Signify Health Medical Associates Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1750845863
PECOS PAC ID: 2163764424
Enrollment ID: O20191001003503 |
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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. Erin Olivia 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 |
|---|
Erin Olivia Clark,
1601 Owen Dr,
Fayetteville, NC 28304-3425
Ph: (910) 678-0100 | Erin Olivia Clark,
1601 Owen Dr,
Fayetteville, NC 28304-3425
Ph: (910) 678-0100 |
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