Jennifer M Clark, RN, FNP - Medicare Nurse Practitioner in Santa Rosa, CA

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Jennifer M Clark, RN, FNP is a medicare enrolled "Nurse Practitioner" in Santa Rosa, California. Her current practice location is 500 Doyle Park Dr Ste G04, Santa Rosa, California. You can reach out to her office (for appointments etc.) via phone at (707) 303-8349.

Jennifer M Clark is licensed to practice in California (license number NP12069) 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 1437335551.

Contact Information

Jennifer M Clark, RN, FNP
500 Doyle Park Dr Ste G04,
Santa Rosa, CA 95405-4559
(707) 303-8349
(707) 303-2694

Map and Direction




Provider's Profile

Full NameJennifer M Clark
GenderFemale
SpecialityNurse Practitioner
Location500 Doyle Park Dr Ste G04, Santa Rosa, California
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1437335551
  • Provider Enumeration Date: 01/18/2008
  • Last Update Date: 07/21/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 0244296226
  • Enrollment ID: I20041202000275

Medical Identifiers

Medical identifiers for Jennifer M Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1437335551NPI-NPPES
193487901MedicaidTX
8Y5099OtherTXBCBS
P00622287OtherTXRR MEDICARE

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363L00000XNurse Practitioner 740722 (Texas)Secondary
363L00000XNurse Practitioner NP12069 (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. Jennifer M Clark allows following entities to bill medicare on her behalf.
Entity NameProvidence Medical Foundation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1285890624
PECOS PAC ID: 8921993205
Enrollment ID: O20040216001346
Entity NameVinod K Valiveti Md Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1245263664
PECOS PAC ID: 2860672656
Enrollment ID: O20110210001143
Entity NameSnf Wound Care
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1114393311
PECOS PAC ID: 1759699176
Enrollment ID: O20151006000251
Entity NameNorth Bay Spine & Neuropathy Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1427683481
PECOS PAC ID: 0941631766
Enrollment ID: O20200512001237

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. Jennifer M 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
Jennifer M Clark, RN, FNP
500 Doyle Park Dr Ste G04,
Santa Rosa, CA 95405-4559

Ph: (707) 303-8349		Jennifer M Clark, RN, FNP
500 Doyle Park Dr Ste G04,
Santa Rosa, CA 95405-4559

Ph: (707) 303-8349

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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