Mariam Clark, NP in Los Angeles, CA - Medicare Nurse Practitioner

Mariam Clark, NP is a medicare enrolled "Nurse Practitioner - Family" in Los Angeles, California. She graduated from nursing school in 2013 and has 11 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice California Wound Healing Medical Group Inc. and her current practice location is 3612 1/2 E 1st St, Los Angeles, California. You can reach out to her office (for appointments etc.) via phone at (323) 264-7796.

Mariam Clark is licensed to practice in California (license number 95000880) and she also participates in the medicare program. She may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1619370194.

Contact Information

	Mariam Clark, NP
	3612 1/2 E 1st St, Los Angeles, CA 90063-2326
	(323) 264-7796
	Not Available

Map and Direction

Provider's Profile

Full Name	Mariam Clark
Gender	Female
Speciality	Nurse Practitioner
Experience	11 Years
Location	3612 1/2 E 1st St, Los Angeles, California
Accepts Medicare Assignments	May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance.

Medical Education and Training:

Mariam Clark graduated from nursing school in 2013

NPI Data:

NPI Number: 1619370194
Provider Enumeration Date: 09/29/2014
Last Update Date: 03/14/2022

Medicare PECOS Information:

PECOS PAC ID: 6800118431
Enrollment ID: I20141209001793

Medical Identifiers

Medical identifiers for Mariam Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1619370194	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	F0714462 (California)	Secondary
363LF0000X	Nurse Practitioner - Family	95000880 (California)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
California Wound Healing Medical Group Inc.	7315033198	8

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. Mariam Clark allows following entities to bill medicare on her behalf.

Entity Name	Carrasco Podiatry Corporation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1043339260 PECOS PAC ID: 2365478245 Enrollment ID: O20050712000777

Entity Name	California Wound Healing Medical Group Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1235333972 PECOS PAC ID: 7315033198 Enrollment ID: O20071010000465

Entity Name	Wound Healing Care Specialists Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1306317961 PECOS PAC ID: 5698019602 Enrollment ID: O20181203001136

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. Mariam 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
Mariam Clark, NP 6551 Harrington Ct, Chino, CA 91710-7376 Ph: (909) 613-9238	Mariam Clark, NP 3612 1/2 E 1st St, Los Angeles, CA 90063-2326 Ph: (323) 264-7796

Reviews and Comments

Nurse Practitioner Nurses in Los Angeles, CA

Prof. Antoinette Zaragoza, NURSE PRACTITIONER Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 245 S. Fetterly Ave, Roybal Comprehensive Chc, Los Angeles, CA 90022 Phone: 323-780-2216
Maria Del Carmen Castillo, N.P. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3000 E 1st St, Los Angeles, CA 90063 Phone: 323-262-6935 Fax: 323-262-3109
Anna Teresa Mendoza Tsay, ANP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3913 York Blvd, Los Angeles, CA 90065 Phone: 323-532-1900
Sherry Hefner Medrano, CPNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 456 S Mathews St, Los Angeles, CA 90033 Phone: 323-780-6502 Fax: 323-780-6685
Miss Martha Emily Muriel, NURSE PRACTITIONER Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2829 S Grand Ave, Room # 213, Los Angeles, CA 90007 Phone: 213-744-6120 Fax: 213-749-6601
Woosin Chung, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1515 N Vermont Ave Fl 2, Los Angeles, CA 90027 Phone: 213-220-9190
Maria Imelda Bautista-durand, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2400 S Flower St, Los Angeles, CA 90007 Phone: 213-742-1000

Mariam Clark, NP - Medicare Nurse Practitioner in Los Angeles, CA