Mary A Clark, NP is a medicare enrolled "Nurse Practitioner - Family" in Stantonsburg, North Carolina. Her current practice location is
312 South Main St, Stantonsburg, North Carolina. You can reach out to her office (for appointments etc.) via phone at
(252) 238-2757.
Mary A Clark is licensed to practice in North Carolina (license number 0050-02432) 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 1518945732.
Provider's Profile
| Full Name | Mary A Clark |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 312 South Main St, Stantonsburg, North Carolina |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1518945732
- Provider Enumeration Date: 01/06/2006
- Last Update Date: 02/19/2009
Medicare PECOS Information:
- PECOS PAC ID: 0143320861
- Enrollment ID: I20171116002543
Medical Identifiers
Medical identifiers for Mary A Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1518945732 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 0050-02432 (North Carolina) | 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. Mary A Clark allows following entities to bill medicare on her behalf.
| Entity Name | Riverside Physician Services Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1194929026
PECOS PAC ID: 5092608448
Enrollment ID: O20040207000400 |
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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. Mary A 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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Mary A Clark, NP
312 South Main St,
Stantonsburg, NC 27883
Ph: (252) 238-2757 | Mary A Clark, NP
312 South Main St,
Stantonsburg, NC 27883
Ph: (252) 238-2757 |
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