MARY ELLEN CLARK CFNP
NPI 1891031621
Nurse Practitioner - Family in Warren, IN

Q: What is Mary Clark's NPI number?

The NPI number for Mary Clark is 1891031621. It was assigned to this individual provider in the NPPES registry on December 26, 2012. The provider is also known as Mary Ellen Herod.

Q: What is Mary Clark's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Mary Clark was last updated on October 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.

Active since December 26, 2012PECOS EnrolledAccepts Medicare Assignment

824 HUNTINGTON AVE, WARREN, IN 46792(260) 375-2965(260) 375-2969 Get Directions Write a Review

NPPES record last updated: October 7, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 7, 2025, Sep 19, 2025, Jul 16, 2021 (3 updates tracked since 2021).

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About Mary Ellen Clark Cfnp NPPES

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

MARY ELLEN CLARK CFNP (NPI 1891031621) is an individual family provider in Warren, Indiana, licensed in Indiana (71016668A) and active in the NPI registry since December 2012. She is enrolled in Medicare PECOS, is affiliated with Portneuf Medical Center, and is a graduate of Other (2012).

NPPES Registry Identity

NPI1891031621

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMARY ELLEN CLARKCredential: CFNP

Location Address824 HUNTINGTON AVEWarren, IN 46792-9277

Mailing Address240 N Tillotson AveMuncie, IN 47304-3988 · (765) 288-1928 · Fax (765) 741-0335

Phone(260) 375-2965

Fax(260) 375-2969

Sole ProprietorNo

Medical School CMSOtherGraduated 2012

Enumeration DateDecember 26, 2012

Last NPPES UpdateOctober 7, 20253 updates tracked since enumeration

NPPES CertifiedOctober 7, 2025

✔ NPI 1891031621 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

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

Taxonomy Code363LF0000X

Licenses✔ Licensed in IN · 71016668A✔ Licensed in NM · CNP-02460✔ Licensed in OR · 201250210NP

Also ListedNurse Practitioner · Primary CareTaxonomy 363LP2300X · License 66049 (ID)

824 HUNTINGTON AVE, Warren, IN 46792

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Other Names 1

Former Name (1)Mary Ellen Herod

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mary Ellen Clark Cfnp 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 ID9739333824

PECOS Enrollment IDI20250922000426

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.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Portneuf Medical Center

Acute Care Hospitals · Pocatello, ID

4/5 CMS rating

OwnershipProprietary

CMS Certification Number130028

Location777 Hospital WayPocatello, ID 83201 · Bannock County

Emergency services Birthing friendly

Bluffton Regional Medical Center

Acute Care Hospitals · Bluffton, IN

4/5 CMS rating

OwnershipProprietary

CMS Certification Number150075

Location303 S Main StBluffton, IN 46714 · Wells County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46792 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

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$94.22 typical visit price

range $16.93 – $132.22

Typical copayment $23.55 (range $4.23 – $33.05)

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.

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.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

2 suppliers12 claims12 services$16.16 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 6

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

JUDITH A RIPPERGER PAC

Physician Assistant