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MARIAM CLARK NP
NPI 1619370194
Nurse Practitioner - Family in Los Angeles, CA

Active since September 29, 2014PECOS Enrolled
83.24/100
CMS Quality Rating
3612 1/2 E 1ST ST, LOS ANGELES, CA 90063(323) 264-7796 Get Directions Write a Review

NPPES record last updated: March 14, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Mariam Clark Np NPPES

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

MARIAM CLARK NP (NPI 1619370194) is an individual family provider in Los Angeles, California, licensed in California (95000880) and active in the NPI registry since September 2014. She is enrolled in Medicare PECOS and maintains a secondary practice location in Chino.

NPPES Registry Identity

NPI1619370194
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMARIAM CLARKCredential: NP
Location Address3612 1/2 E 1ST STLos Angeles, CA 90063-2326
Mailing Address6551 Harrington CtChino, CA 91710-7376 · (909) 613-9238
Phone(323) 264-7796
Sole ProprietorNo
Enumeration DateSeptember 29, 2014
Last NPPES UpdateMarch 14, 2022
NPPES CertifiedMarch 14, 2022
✔ NPI 1619370194 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in CA · 95000880✔ Licensed in CA · F0714462
3612 1/2 E 1ST ST, Los Angeles, CA 90063
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Secondary Practice Location 1

Location 16551 Harrington CtChino, CA 91710-7376 · Phone (909) 613-9238

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mariam Clark 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

3

Medicare enrollment records show Mariam Clark reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

California Wound Healing Medical Group Inc.
4.6 mi
Surgical
100 E HUNTINGTON DR STE 209
Alhambra, CA 91801
  • Reassigned Medicare billing, California enrollment
  • 50 clinicians in this Medicare group
NPI 1235333972 (323) 264-7796
Healing Edge Medical Group - Ca
5.8 mi
Surgical
100 E HUNTINGTON DR STE 203
Alhambra, CA 91801
  • Reassigned Medicare billing, California enrollment
  • 21 clinicians in this Medicare group
NPI 1982432506 (323) 264-7796
Carrasco Podiatry Corporation
39 mi
Podiatrist
7196 SUNNYSIDE PL
Rancho Cucamonga, CA 91739
  • Reassigned Medicare billing, California enrollment
  • 23 clinicians in this Medicare group
NPI 1043339260 (951) 212-6661

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

Areas of Expertise CMS Part B claims 14

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of muscle and/or tissue, each additional 20.0 sq cm or less 11046
This procedure involves the removal of muscle and/or tissue, typically to treat disease or injury. An additional 20.0 square cm or less of tissue may be removed if necessary. The process is performed by a skilled medical professional to ensure your safety and recovery.
677 services58 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
616 services131 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
582 services246 patients
Removal of skin and tissue, each additional 20.0 sq cm or less 11045
This procedure involves the removal of skin and tissue, typically due to disease, injury, or abnormal growth. Each session removes an area of 20.0 square cm or less. It's performed by a trained professional and may require multiple sessions for larger areas.
483 services65 patients
Removal of muscle and/or tissue, 20.0 sq cm or less 11043
This procedure involves the surgical removal of a specified area (20.0 sq cm or less) of muscle and/or tissue. It's typically done to treat conditions like tumors, infections, or injuries. Local or general anesthesia ensures comfort. Recovery time varies.
426 services104 patients
Removal of skin and tissue, 20.0 sq cm or less 11042
This procedure involves the surgical removal of skin and tissue, up to 20.0 square cm in size. It's often performed to treat conditions like skin cancer or to remove moles, warts, and other skin lesions. The area is numbed and the unwanted tissue is carefully cut out.
398 services127 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90063 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
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.24/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality68.51
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Gastrostomy/jejunostomy tube, low-profile, any material, any type, each B4088
Other-Enteral and Parenteral · category OB006N
1 supplier13 claims13 services$28.63 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 5

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

MAIDA ELENA JACKSON FNP
Nurse Practitioner (Family)
3612 1/2 E 1ST ST
LOS ANGELES, CA 90063
Los Angeles County (323) 264-7796
FRANK LUIS JIMENEZ PA-C
Physician Assistant
3612 1/2 E 1ST ST
LOS ANGELES, CA 90063
Los Angeles County (323) 264-7796
ERIKA LEPE PA-C
Physician Assistant
3612 1/2 E 1ST ST
LOS ANGELES, CA 90063
Los Angeles County (323) 264-7796
LINQ MEDICAL SERVICES INC.
Internal Medicine (Critical Care Medicine)
3612 1/2 E 1ST ST
LOS ANGELES, CA 90063
Los Angeles County (323) 264-7796
ON-SITE PODIATRY SERVICES, INC.
Podiatrist (Foot & Ankle Surgery)
3612 1/2 E 1ST ST
LOS ANGELES, CA 90063
Los Angeles County (323) 262-4146

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 Mariam Clark's NPI number?

The NPI number for Mariam Clark is 1619370194. It was assigned to this individual provider in the NPPES registry on September 29, 2014.

Where is Mariam Clark located?

Mariam Clark practices at 3612 1/2 E 1st St, Los Angeles, CA 90063. The listed phone number is (323) 264-7796.

What is Mariam Clark's specialty?

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

Is Mariam Clark enrolled in Medicare?

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

Which organizations bill Medicare for Mariam Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mariam Clark reassigns Medicare benefits to 3 organizations: California Wound Healing Medical Group Inc. (Alhambra, CA), Healing Edge Medical Group - Ca (Alhambra, CA) and Carrasco Podiatry Corporation (Rancho Cucamonga, CA). 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 Mariam 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 Mariam Clark was last updated on March 14, 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.