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ILLISE CLARK FNP-NP
NPI 1396004776
Nurse Practitioner - Family in Mentor, OH

Active since May 07, 2012PECOS Enrolled
8881 SCHAEFFER ST, MENTOR, OH 44060(440) 255-9309 Get Directions Write a Review

NPPES record last updated: May 12, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 12, 2026, Jul 3, 2018 (2 updates tracked since 2018).

About Illise Clark Fnp-np NPPES

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

ILLISE CLARK FNP-NP (NPI 1396004776) is an individual family provider in Mentor, Ohio, licensed in Ohio (APRN.CNP.0022454) and active in the NPI registry since May 2012. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1396004776
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameILLISE CLARKCredential: FNP-NP
Location Address8881 SCHAEFFER STMentor, OH 44060-5035
Mailing Address8881 Schaeffer StMentor, OH 44060-5035 · (440) 255-9309
Phone(440) 255-9309
Sole ProprietorNo
Enumeration DateMay 7, 2012
Last NPPES UpdateMay 12, 20262 updates tracked since enumeration
NPPES CertifiedMay 12, 2026
✔ NPI 1396004776 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in OH · APRN.CNP.0022454
Also ListedRegistered NurseTaxonomy 163W00000X · License RN.371331 (OH)
8881 SCHAEFFER ST, Mentor, OH 44060
Open in Google Maps ↗

Other Identifiers 1

Medicaid0268768OH

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Illise Clark Fnp-np 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.

Medicare Billing Reassignments

2

Medicare enrollment records show Illise Clark reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Uh Regional Hospitals
13 mi
Nurse Practitioner
13207 RAVENNA RD
Chardon, OH 44024
  • Reassigned Medicare billing, Ohio enrollment
  • 42 clinicians in this Medicare group
NPI 1962886002 (440) 285-6000
Longevity Clinical Ltc Associates Of Ohio, Inc.
30 mi
Gerontology
12380 PLAZA DR
Parma, OH 44130
  • Reassigned Medicare billing, Ohio enrollment
  • 14 clinicians in this Medicare group
NPI 1114609815 (216) 898-8399

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 44060 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
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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 3

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

WESTERN RESERVE HEALTHCARE CO., LLC
Skilled Nursing Facility
8881 SCHAEFFER ST
MENTOR, OH 44060
Lake County (440) 266-3909
DR. CALLAWAY BENJAMIN SLUSARZ DPT
Physical Therapist
8881 SCHAEFFER ST
MENTOR, OH 44060
Lake County (440) 255-9309
MENTOR WAY NURSING & REHABILITATION CENTER, INC.
Skilled Nursing Facility
8881 SCHAEFFER ST
MENTOR, OH 44060
Lake County (440) 255-9309

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 Illise Clark's NPI number?

The NPI number for Illise Clark is 1396004776. It was assigned to this individual provider in the NPPES registry on May 7, 2012.

Where is Illise Clark located?

Illise Clark practices at 8881 Schaeffer St, Mentor, OH 44060. The listed phone number is (440) 255-9309.

What is Illise Clark's specialty?

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

Is Illise Clark enrolled in Medicare?

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

Which organizations bill Medicare for Illise Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Illise Clark reassigns Medicare benefits to 2 organizations: Uh Regional Hospitals (Chardon, OH) and Longevity Clinical Ltc Associates Of Ohio, Inc. (Parma, OH). Each 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 Illise 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 Illise Clark was last updated on May 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.