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TIMETRA DIANE CLARK FNP-BC
NPI 1316687650
Nurse Practitioner - Family in Chicago, IL

Active since April 01, 2022PECOS Enrolled
1401 E 55TH ST APT 905N, CHICAGO, IL 60615(708) 759-3112 Get Directions Write a Review

NPPES record last updated: April 1, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Timetra Diane Clark Fnp-bc NPPES

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

TIMETRA DIANE CLARK FNP-BC (NPI 1316687650) is an individual family provider in Chicago, Illinois, licensed in Illinois (209024791) and active in the NPI registry since April 2022. She is enrolled in Medicare PECOS and maintains a secondary practice location in San Antonio.

NPPES Registry Identity

NPI1316687650
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameTIMETRA DIANE CLARKCredential: FNP-BC
Location Address1401 E 55TH ST APT 905NChicago, IL 60615-5468
Mailing Address1401 E 55th St Apt 905nChicago, IL 60615-5468 · (708) 759-3112
Phone(708) 759-3112
Sole ProprietorYes
Enumeration DateApril 1, 2022
NPPES CertifiedApril 1, 2022
✔ NPI 1316687650 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 209024791
Also ListedRegistered Nurse · NephrologyTaxonomy 163WN0300X · License 041436444 (IL), 9562544 (FL)
Also ListedNurse PractitionerTaxonomy 363L00000X · License 209024791 (IL)
1401 E 55TH ST APT 905N, Chicago, IL 60615
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Secondary Practice Location 1

Location 111026 Pony GateSan Antonio, TX 78254-5999 · Phone (847) 616-0269

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Timetra Diane Clark Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60615 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
$94.06 typical visit price
range $60.08 – $183.39
Typical copayment $23.51 (range $15.02 – $45.84)
Most-billed visit code 99203
Established Patient
$105.70 typical visit price
range $18.97 – $148.12
Typical copayment $26.42 (range $4.74 – $37.03)
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

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

HANDS ON HOLISTIC HEALTH PLLC
Occupational Therapist
1401 E 55TH ST APT 905N
CHICAGO, IL 60615
Cook County (773) 413-8443

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 Timetra Clark's NPI number?

The NPI number for Timetra Clark is 1316687650. It was assigned to this individual provider in the NPPES registry on April 1, 2022.

Where is Timetra Clark located?

Timetra Clark practices at 1401 E 55th St Apt 905N, Chicago, IL 60615. The listed phone number is (708) 759-3112.

What is Timetra Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Timetra Clark enrolled in Medicare?

Yes. Timetra Clark is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Timetra Clark was last updated on April 1, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.