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SHANAVIER CLARK
NPI 1477044071
Social Worker in Gulfport, MS

Active since May 21, 2018PECOS EnrolledAccepts Medicare Assignment
15024 MARTIN LUTHER KING JR BLVD, GULFPORT, MS 39501(228) 864-0003(228) 863-7917 Get Directions Write a Review

NPPES record last updated: November 24, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 24, 2025, May 21, 2018 (2 updates tracked since 2018).

About Shanavier Clark NPPES

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

SHANAVIER CLARK (NPI 1477044071) is an individual social worker in Gulfport, Mississippi, licensed in Mississippi (C11808) and active in the NPI registry since May 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1477044071
Entity TypeIndividualFemale
Primary Taxonomy104100000X
Provider Legal NameSHANAVIER CLARK
Location Address15024 MARTIN LUTHER KING JR BLVDGulfport, MS 39501-8306
Mailing Address10467 Corporate DrGulfport, MS 39503-4634 · (228) 374-2494 · Fax (228) 396-3457
Phone(228) 864-0003
Fax(228) 863-7917
Sole ProprietorYes
Medical School CMSOtherGraduated 2017
Enumeration DateMay 21, 2018
Last NPPES UpdateNovember 24, 20252 updates tracked since enumeration
NPPES CertifiedNovember 24, 2025
✔ NPI 1477044071 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
License✔ Licensed in MS · C11808
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
15024 MARTIN LUTHER KING JR BLVD, Gulfport, MS 39501
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter Health and more.Insurance ›

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

Shanavier Clark 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 ID6002392503
PECOS Enrollment IDI20260114004034
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 Shanavier Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Coastal Family Health Center, Inc.
Same address
Federally Qualified Health Center (FQHC)
15024 MARTIN LUTHER KING JR BLVD
Gulfport, MS 39501
  • Reassigned Medicare billing, Mississippi enrollment
  • 90 clinicians in this Medicare group
NPI 1841220357 (228) 864-0003

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 18

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

COASTAL FAMILY HEALTH CENTER INC
Clinic/Center (Community Health)
15024 MARTIN LUTHER KING JR BLVD
GULFPORT, MS 39501
Harrison County (228) 864-0003
JONETTE SCOTT M.D.
Pediatrics
15024 MARTIN LUTHER KING JR BLVD
GULFPORT, MS 39501
Harrison County (228) 864-0003
COASTAL FAMILY HEALTH CENTER
Clinic/Center (Dental)
15024 MARTIN LUTHER KING JR BLVD
GULFPORT, MS 39501
Harrison County (228) 863-9781
MRS. TIFFANIE MARIE FERRY FNP-C
Nurse Practitioner (Family)
15024 MARTIN LUTHER KING JR BLVD
GULFPORT, MS 39501
Harrison County (228) 864-0003
LUELLA A WILLIAMS CFNP
Nurse Practitioner (Family)
15024 MARTIN LUTHER KING JR BLVD
GULFPORT, MS 39501
Harrison County (228) 864-0003
PAUL J ROUSE DMD
Dentist
15024 MARTIN LUTHER KING JR BLVD
GULFPORT, MS 39501
Harrison County (228) 863-9781
SAFIA MOHIUDDIN MD
Preventive Medicine (Public Health & General Preventive Medicine)
15024 MARTIN LUTHER KING JR BLVD
GULFPORT, MS 39501
Harrison County (228) 374-2494
MRS. REBEKAH FAITH DANIELS WHNP-BC
Nurse Practitioner (Women's Health)
15024 MARTIN LUTHER KING JR BLVD
GULFPORT, MS 39501
Harrison County (228) 864-0003

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 Shanavier Clark's NPI number?

The NPI number for Shanavier Clark is 1477044071. It was assigned to this individual provider in the NPPES registry on May 21, 2018.

Where is Shanavier Clark located?

Shanavier Clark practices at 15024 Martin Luther King Jr Blvd, Gulfport, MS 39501. The listed phone number is (228) 864-0003.

What is Shanavier Clark's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Shanavier Clark enrolled in Medicare?

Yes. Shanavier 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 Shanavier Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shanavier Clark reassigns Medicare benefits to Coastal Family Health Center, Inc. (Gulfport, MS). 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 Shanavier Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shanavier Clark accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 2 other insurers list Shanavier 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 Shanavier Clark was last updated on November 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.