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CARLY CLARK
NPI 1356921746
Student in an Organized Health Care Education/Training Program in Fort Collins, CO

Active since April 10, 2021PECOS Enrolled
4601 S MASON ST, FORT COLLINS, CO 80525(970) 493-5334 Get Directions Write a Review

NPPES record last updated: August 21, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 21, 2026, Apr 10, 2021 (2 updates tracked since 2021).

About Carly Clark NPPES

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

CARLY CLARK (NPI 1356921746) is an individual student in an organized health care education/training program in Fort Collins, Colorado and active in the NPI registry since April 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1356921746
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameCARLY CLARK
Location Address4601 S MASON STFort Collins, CO 80525-3740
Mailing Address4601 S Mason StFort Collins, CO 80525-3740
Phone(970) 493-5334
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateApril 10, 2021
Last NPPES UpdateAugust 21, 20262 updates tracked since enumeration
NPPES CertifiedAugust 21, 2026
✔ NPI 1356921746 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4601 S MASON ST, Fort Collins, CO 80525
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Select Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Carly Clark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3173081502
PECOS Enrollment IDI20260817001780
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 Carly Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Poudre Valley Medical Group, LLC
8.3 mi
General Practice
2695 ROCKY MOUNTAIN AVE STE 110
Loveland, CO 80538
  • Reassigned Medicare billing, Colorado enrollment
  • 2,596 clinicians in this Medicare group
NPI 1225356868 (970) 624-4443

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 9

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

ROSS SHELINE M.D.
Family Medicine
4601 S MASON ST
FORT COLLINS, CO 80525
Larimer County (970) 266-3600
LINDSEY CELENE MOYER FNP-BC
Nurse Practitioner (Family)
4601 S MASON ST
FORT COLLINS, CO 80525
Larimer County (970) 266-3600
ALISON PAIGE BROYLES MD
Family Medicine
4601 S MASON ST
FORT COLLINS, CO 80525
Larimer County (970) 266-3600
MONICA T SERRANO TOY MD
Family Medicine
4601 S MASON ST
FORT COLLINS, CO 80525
Larimer County (970) 266-3600
AMANDA LOPEZ
Registered Nurse
4601 S MASON ST
FORT COLLINS, CO 80525
Larimer County (970) 266-3600
MAX HARRIS MD
Family Medicine
4601 S MASON ST
FORT COLLINS, CO 80525
Larimer County (970) 266-3600
POUDRE VALLEY MEDICAL GROUP, LLC
Family Medicine
4601 S MASON ST
FORT COLLINS, CO 80525
Larimer County (970) 493-5334
SIERRA TYYNE JOHNSON
Audiologist
4601 S MASON ST
FORT COLLINS, CO 80525
Larimer County (970) 493-5334

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 Carly Clark's NPI number?

The NPI number for Carly Clark is 1356921746. It was assigned to this individual provider in the NPPES registry on April 10, 2021.

Where is Carly Clark located?

Carly Clark practices at 4601 S Mason St, Fort Collins, CO 80525. The listed phone number is (970) 493-5334.

What is Carly Clark's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Carly Clark enrolled in Medicare?

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

Which organization bills Medicare for Carly Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Carly Clark reassigns Medicare benefits to Poudre Valley Medical Group, LLC (Loveland, CO). 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 Carly Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Carly Clark accept?

Health plans from Select Health list Carly Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Carly Clark was last updated on August 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.