MR. PHILLIP WAYNE CLARK DNP
NPI 1629471412
Nurse Practitioner - Family in Creve Coeur, MO
About Mr. Phillip Wayne Clark Dnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. PHILLIP WAYNE CLARK DNP (NPI 1629471412) is an individual family provider in Creve Coeur, Missouri, licensed in Arizona (AP 7468) and active in the NPI registry since October 2014. He is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Other (2014).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 3
Accepted 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
Mr. Phillip Wayne Clark Dnp 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.
Medicare Billing Reassignments
3Medicare enrollment records show Phillip Clark reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Poplar Bluff, MO 63901
- Reassigned Medicare billing, Missouri enrollment
- 102 clinicians in this Medicare group
Gilbert, AZ 85233
- Reassigned Medicare billing, Arizona enrollment
- Medicare enrollment name: Jewish Family & Childrens Service
- 136 clinicians in this Medicare group
Prescott, AZ 86301
- Reassigned Medicare billing, Arizona enrollment
- 214 clinicians in this Medicare group
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 63141 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
CREVE COEUR, MO 63141
CREVE COEUR, MO 63141
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 Phillip Clark's NPI number?
The NPI number for Phillip Clark is 1629471412. It was assigned to this individual provider in the NPPES registry on October 7, 2014.
Where is Phillip Clark located?
Phillip Clark practices at 11560 Olive Blvd, Creve Coeur, MO 63141. The listed phone number is (314) 995-7128.
What is Phillip Clark's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Phillip Clark enrolled in Medicare?
Yes. Phillip 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 organizations bill Medicare for Phillip Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Phillip Clark reassigns Medicare benefits to 3 organizations: Missouri Hb Medical Services, LLC (Poplar Bluff, MO), Jewish Family & Children's Service (Gilbert, AZ) and Prescott Healthcare Solutions LLC (Prescott, AZ). 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 Phillip Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Phillip Clark accept?
Health plans from Blue Cross Blue Shield of Arizona list Phillip 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 Phillip Clark was last updated on March 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Mr. Phillip Wayne Clark, DNP · NPI 1629471412
Family physician in Creve Coeur, Missouri. Individual provider, active in the CMS NPPES registry since October 7, 2014.
## Identity
- **NPI:** 1629471412 (Entity type: Individual)
- **Enumerated:** October 7, 2014
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** AP 7468 (Arizona)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 11560 OLIVE BLVD, Creve Coeur, MO 63141-7111
- **Phone:** (314) 995-7128 · **Fax:** (314) 995-7221
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Missouri Hb Medical Services, LLC (NPI 1922868462, Poplar Bluff, MO); Jewish Family & Children's Service (NPI 1881680254, Gilbert, AZ); Prescott Healthcare Solutions LLC (NPI 1821454505, Prescott, AZ) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2014
## Record status
- **NPPES last updated:** March 31, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1629471412) · Data from the CMS NPPES public registry.