Dominique Clark, FNP-C - Medicare Nurse Practitioner in Cordova, TN

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Dominique Clark, FNP-C is a medicare enrolled "Nurse Practitioner - Family" in Cordova, Tennessee. She graduated from nursing school in 2019 and has 5 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Poplar Avenue Clinic, Pllc and her current practice location is 1540 Appling Care Ln, Cordova, Tennessee. You can reach out to her office (for appointments etc.) via phone at (901) 444-3950.

Dominique Clark is licensed to practice in Tennessee (license number 27344) 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 1346874716.

Contact Information

Dominique Clark, FNP-C
1540 Appling Care Ln,
Cordova, TN 38016-4957
(901) 444-3950
Not Available

Map and Direction




Provider's Profile

Full NameDominique Clark
GenderFemale
SpecialityNurse Practitioner
Experience5 Years
Location1540 Appling Care Ln, Cordova, Tennessee
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Dominique Clark graduated from nursing school in 2019
  NPI Data:
  • NPI Number: 1346874716
  • Provider Enumeration Date: 02/25/2020
  • Last Update Date: 11/13/2020
  Medicare PECOS Information:
  • PECOS PAC ID: 6608291687
  • Enrollment ID: I20200807001732

Medical Identifiers

Medical identifiers for Dominique Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1346874716NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
163WE0003XRegistered Nurse - Emergency 174756 (Tennessee)Secondary
363LF0000XNurse Practitioner - Family 27344 (Tennessee)Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Poplar Avenue Clinic, Pllc004255245712

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. Dominique Clark allows following entities to bill medicare on her behalf.
Entity NameT M Carr Md Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1992706097
PECOS PAC ID: 3375504913
Enrollment ID: O20041026000787
Entity NameThe Little Clinic Of Tennessee Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1487848800
PECOS PAC ID: 4688762800
Enrollment ID: O20080326000339
Entity NameCordova Pain Specialists, Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1437565900
PECOS PAC ID: 1759500523
Enrollment ID: O20140910001813
Entity NameCarr, Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1548677610
PECOS PAC ID: 1850512153
Enrollment ID: O20141030001974
Entity NamePoplar Avenue Clinic, Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1124588793
PECOS PAC ID: 0042552457
Enrollment ID: O20190515003081

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. Dominique 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 AddressPractice Location Address
Dominique Clark, FNP-C
1540 Appling Care Ln Ste 105,
Cordova, TN 38016-4947

Ph: (901) 444-3970		Dominique Clark, FNP-C
1540 Appling Care Ln,
Cordova, TN 38016-4957

Ph: (901) 444-3950

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

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