CHRISTINA MARIE CLACK PNP (C)
NPI 1699365601
Nurse Practitioner - Pediatrics in Los Angeles, CA

Q: 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.

Q: What is Christina Clack's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Q: When was this NPI record last updated?

The NPPES record for Christina Clack was last updated on July 17, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since January 23, 2021PECOS Enrolled

808 W 58TH ST, LOS ANGELES, CA 90037(323) 541-1600 Get Directions Write a Review

NPPES record last updated: July 17, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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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

NPI1699365601

Entity TypeIndividualFemale

Primary Taxonomy363LP0200X

Provider Legal NameCHRISTINA MARIE CLACKCredential: PNP (C)

Location Address808 W 58TH STLos Angeles, CA 90037-3632

Mailing Address3153 Rollings AveThousand Oaks, CA 91360-6433 · (805) 990-3730

Phone(323) 541-1600

Sole ProprietorNo

Enumeration DateJanuary 23, 2021

Last NPPES UpdateJuly 17, 2025

NPPES CertifiedJuly 17, 2025

✔ NPI 1699365601 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0200X

License✔ Licensed in CA · 95015295

Also ListedNurse PractitionerTaxonomy 363L00000X · License 95015295 (CA)

808 W 58TH ST, Los Angeles, CA 90037

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Secondary Practice Location 1

Location 12601 E Main St Ste 200Ventura, CA 93003-2801 · Phone (805) 643-7500 · Fax (805) 643-7510

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Christina Marie Clack Pnp (c) 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.

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.

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.