JEANINE CLARK FNP
NPI 1023509452
Nurse Practitioner - Family in Stockbridge, GA
About Jeanine Clark Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JEANINE CLARK FNP (NPI 1023509452) is an individual family provider in Stockbridge, Georgia, licensed in Georgia (RN243362) and active in the NPI registry since May 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jeanine Clark Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jeanine Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Mcdonough, GA 30253
- Reassigned Medicare billing, Georgia enrollment
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30281 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 7
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jeanine Clark's NPI number?
The NPI number for Jeanine Clark is 1023509452. It was assigned to this individual provider in the NPPES registry on May 21, 2018.
Where is Jeanine Clark located?
Jeanine Clark practices at 175 Medical Blvd, Stockbridge, GA 30281. The listed phone number is (239) 443-8018.
What is Jeanine Clark's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Jeanine Clark enrolled in Medicare?
Yes. Jeanine Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jeanine Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jeanine Clark reassigns Medicare benefits to En Bonne Sante Clinic LLC (Mcdonough, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jeanine Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jeanine Clark was last updated on August 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jeanine Clark, FNP · NPI 1023509452
Family physician in Stockbridge, Georgia. Individual provider, active in the CMS NPPES registry since May 21, 2018.
## Identity
- **NPI:** 1023509452 (Entity type: Individual)
- **Enumerated:** May 21, 2018
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** RN243362 (Georgia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 175 MEDICAL BLVD, Stockbridge, GA 30281-5083
- **Phone:** (239) 443-8018
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** En Bonne Sante Clinic LLC (NPI 1952134512, Mcdonough, GA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** August 20, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1023509452) · Data from the CMS NPPES public registry.