CHRISTINA MARIE CLACK PNP (C)
NPI 1699365601
Nurse Practitioner - Pediatrics in Los Angeles, CA
About Christina Marie Clack Pnp (c) NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CHRISTINA MARIE CLACK PNP (C) (NPI 1699365601) is an individual pediatrics provider in Los Angeles, California, licensed in California (95015295) and active in the NPI registry since January 2021. She is enrolled in Medicare PECOS and maintains a secondary practice location in Ventura.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Christina Marie Clack Pnp (c) is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Christina Clack reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Los Angeles, CA 90037
- Reassigned Medicare billing, California enrollment
- Medicare enrollment name: St. John's Community Health
- 404 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 90037 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.
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 Christina Clack's NPI number?
The NPI number for Christina Clack is 1699365601. It was assigned to this individual provider in the NPPES registry on January 23, 2021.
Where is Christina Clack located?
Christina Clack practices at 808 W 58th St, Los Angeles, CA 90037. The listed phone number is (323) 541-1600.
What is Christina Clack's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.
Is Christina Clack enrolled in Medicare?
Yes. Christina Clack is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Christina Clack's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Christina Clack reassigns Medicare benefits to St. Johns Community Health (Los Angeles, CA). 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 Christina Clack'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 Christina Clack was last updated on July 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.
# Christina Marie Clack, PNP (C) · NPI 1699365601
Pediatrics physician in Los Angeles, California. Individual provider, active in the CMS NPPES registry since January 23, 2021.
## Identity
- **NPI:** 1699365601 (Entity type: Individual)
- **Enumerated:** January 23, 2021
- **Primary specialty:** Nurse Practitioner - Pediatrics · taxonomy 363LP0200X
- **State license:** 95015295 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 808 W 58TH ST, Los Angeles, CA 90037-3632
- **Phone:** (323) 541-1600
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for durable medical equipment, power mobility devices
- **Bills Medicare through:** St. Johns Community Health (NPI 1073363768, Los Angeles, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 17, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1699365601) · Data from the CMS NPPES public registry.