ANDREA CLARK PNP- PC/AC
NPI 1295457364
Nurse Practitioner - Pediatrics in Phoenix, AZ

Q: What is Andrea Clark's NPI number?

The NPI number for Andrea Clark is 1295457364. It was assigned to this individual provider in the NPPES registry on September 15, 2022.

Q: What is Andrea Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Q: When was this NPI record last updated?

The NPPES record for Andrea Clark was last updated on June 21, 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.

Active since September 15, 2022PECOS EnrolledAccepts Medicare Assignment

1919 E THOMAS RD, PHOENIX, AZ 85016(602) 933-1900(602) 933-1918 Get Directions Write a Review

NPPES record last updated: June 21, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 21, 2024, Sep 1, 2023, Sep 15, 2022 (3 updates tracked since 2022).

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About Andrea Clark Pnp- Pc/ac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANDREA CLARK PNP- PC/AC (NPI 1295457364) is an individual pediatrics provider in Phoenix, Arizona, licensed in Arizona (264063) and active in the NPI registry since September 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1295457364

Entity TypeIndividualFemale

Primary Taxonomy363LP0200X

Provider Legal NameANDREA CLARKCredential: PNP- PC/AC

Location Address1919 E THOMAS RDPhoenix, AZ 85016-7710

Mailing Address2108 E Thomas Rd Ste 130Phoenix, AZ 85016-0008 · (602) 933-1813

Phone(602) 933-1900

Fax(602) 933-1918

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateSeptember 15, 2022

Last NPPES UpdateJune 21, 20243 updates tracked since enumeration

NPPES CertifiedJune 21, 2024

✔ NPI 1295457364 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0200X

License✔ Licensed in AZ · 264063

1919 E THOMAS RD, Phoenix, AZ 85016

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Other Identifiers 1

Medicaid156185AZ

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

Andrea Clark Pnp- Pc/ac 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.

PECOS PAC ID5597134296

PECOS Enrollment IDI20221219001674

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Andrea Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Phoenix Children's Hospital

Same address

Pediatrics

1919 E THOMAS RD
Phoenix, AZ 85016

Reassigned Medicare billing, Arizona enrollment
1,416 clinicians in this Medicare group

NPI 1922112044 (602) 933-1000

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 85016 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.89 typical visit price

range $55.44 – $168.60

Typical copayment $21.47 (range $13.86 – $42.15)

Most-billed visit code 99203

Established Patient

$98.00 typical visit price

range $17.72 – $137.41

Typical copayment $24.50 (range $4.43 – $34.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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