Carrie Ann Clark, FNP is a medicare enrolled "Clinical Nurse Specialist - Family Health" in Los Gatos, California. She graduated from nursing school in 2017 and has 7 years of diverse experience with area of expertise as Nurse Practitioner. Her current practice location is
340 Dardanelli Ln Ste 10, Los Gatos, California. You can reach out to her office (for appointments etc.) via phone at
(408) 412-8100.
Carrie Ann Clark is licensed to practice in California (license number 2017026979) 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 1285137588.
Provider's Profile
| Full Name | Carrie Ann Clark |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 7 Years |
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| Location | 340 Dardanelli Ln Ste 10, Los Gatos, California |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Carrie Ann Clark graduated from nursing school in 2017
NPI Data:
- NPI Number: 1285137588
- Provider Enumeration Date: 03/13/2018
- Last Update Date: 08/19/2022
Medicare PECOS Information:
- PECOS PAC ID: 5991060279
- Enrollment ID: I20180608000022
Medical Identifiers
Medical identifiers for Carrie Ann Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1285137588 | NPI | - | NPPES |
| 2017026979 | Other | CA | AMERICAN NURSE CREDENTIALING CENTER |
| CA303447 | Other | CA | MEDICARE PTAN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 364SF0001X | Clinical Nurse Specialist - Family Health | 2017026979 (California) | Primary |
Medical Facilities Affiliation
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. Carrie Ann Clark allows following entities to bill medicare on her behalf.
| Entity Name | Orthonorcal Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1124398235
PECOS PAC ID: 2567623390
Enrollment ID: O20120420000663 |
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| Entity Name | Pontine Incorporated |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1053757609
PECOS PAC ID: 1052550266
Enrollment ID: O20130722000133 |
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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. Carrie Ann 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 |
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Carrie Ann Clark, FNP
1115 Janis Way,
San Jose, CA 95125-3635
Ph: (408) 412-8100 | Carrie Ann Clark, FNP
340 Dardanelli Ln Ste 10,
Los Gatos, CA 95032-1418
Ph: (408) 412-8100 |
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