Dr Nicole C Clark, DO in Lebanon, IN - Medicare Family Practice

Dr Nicole C Clark, DO is a medicare enrolled "Family Medicine" physician in Lebanon, Indiana. She graduated from medical school in 2018 and has 6 years of diverse experience with area of expertise as Family Practice. She is a member of the group practice Witham Memorial Hospital and her current practice location is 2705 N Lebanon St Ste 300, Lebanon, Indiana. You can reach out to her office (for appointments etc.) via phone at (765) 485-8649.

Dr Nicole C Clark is licensed to practice in Indiana (license number 02006481A) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1083110225.

Contact Information

	Dr Nicole C Clark, DO
	2705 N Lebanon St Ste 300, Lebanon, IN 46052-8622
	(765) 485-8649
	(765) 485-8650

Map and Direction

Physician's Profile

Full Name	Dr Nicole C Clark
Gender	Female
Speciality	Family Practice
Experience	6 Years
Location	2705 N Lebanon St Ste 300, Lebanon, Indiana
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Dr Nicole C Clark graduated from medical school in 2018

NPI Data:

NPI Number: 1083110225
Provider Enumeration Date: 04/05/2018
Last Update Date: 10/10/2023

Medicare PECOS Information:

PECOS PAC ID: 6305191461
Enrollment ID: I20210727000749

Medical Identifiers

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

Identifier	Type	State	Issuer
1083110225	NPI	-	NPPES
300014551	Medicaid	IN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	02006481A (Indiana)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Witham Health Services	Lebanon, IN	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Witham Memorial Hospital	4082523170	93

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. Dr Nicole C Clark allows following entities to bill medicare on her behalf.

Entity Name	Witham Memorial Hospital
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1083750293 PECOS PAC ID: 4082523170 Enrollment ID: O20040519001402

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. Dr Nicole C 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
Dr Nicole C Clark, DO 2605 N Lebanon St, Lebanon, IN 46052-1476 Ph: () -	Dr Nicole C Clark, DO 2705 N Lebanon St Ste 300, Lebanon, IN 46052-8622 Ph: (765) 485-8649

Reviews and Comments

Family Medicine Doctors in Lebanon, IN

Emma Joy Nordstrom, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2705 N Lebanon St Ste 300, Lebanon, IN 46052 Phone: 765-485-8649 Fax: 765-485-8650
Mojgan Sarmadi, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 504 W Camp St, Lebanon, IN 46052 Phone: 765-482-7005
James Anthony Boudreau, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2705 N Lebanon St Ste 300, Lebanon, IN 46052 Phone: 765-485-8649 Fax: 765-485-8650
Patrick Doolan, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 504 W Camp St, Lebanon, IN 46052 Phone: 765-482-7005 Fax: 765-483-3021
Dr. John Jacob Saalwaechter, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 504 W Camp St, Lebanon, IN 46052 Phone: 765-482-7005 Fax: 765-483-3023
Justin David Wright, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2705 N Lebanon St Ste 300, Lebanon, IN 46052 Phone: 765-485-8649 Fax: 765-485-8650

Dr Nicole C Clark, DO - Medicare Family Practice in Lebanon, IN