Callandra Clark, is a medicare enrolled "Advanced Practice Midwife" in Santa Clarita, California. Her current practice location is
20420 Victory Ct, Santa Clarita, California. You can reach out to her office (for appointments etc.) via phone at
(661) 252-8987.
Callandra Clark is licensed to practice in California (license number 1713) 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 1023151594.
Provider's Profile
| Full Name | Callandra Clark |
|---|
| Gender | Female |
|---|
| Speciality | Advanced Practice Midwife |
|---|
| Location | 20420 Victory Ct, Santa Clarita, California |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1023151594
- Provider Enumeration Date: 02/15/2007
- Last Update Date: 03/07/2023
Medicare PECOS Information:
- PECOS PAC ID: 7113261652
- Enrollment ID: I20181210003041
Medical Identifiers
Medical identifiers for Callandra Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1023151594 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 163W00000X | Registered Nurse | 669232 (California) | Secondary |
| 367A00000X | Advanced Practice Midwife | 1713 (California) | 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. Callandra Clark allows following entities to bill medicare on her behalf.
| Entity Name | Southern California Permanente Medical Group |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1770515280
PECOS PAC ID: 6002729175
Enrollment ID: O20031110000678 |
|---|
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. Callandra 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 |
|---|
Callandra Clark,
20420 Victory Ct,
Santa Clarita, CA 91350-8531
Ph: (661) 252-8987 | Callandra Clark,
20420 Victory Ct,
Santa Clarita, CA 91350-8531
Ph: (661) 252-8987 |
Reviews and Comments