Altheresa Clark, is a medicare enrolled "Social Worker - Clinical" provider in Miami, Florida. Her current practice location is
111 Nw 183rd St Ste 404, Miami, Florida. You can reach out to her office (for appointments etc.) via phone at
(786) 524-4001.
Altheresa Clark is licensed to practice in Florida (license number SW13295) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1710332333.
Healthcare Provider's Profile
| Full Name | Altheresa Clark |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 111 Nw 183rd St Ste 404, Miami, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1710332333
- Provider Enumeration Date: 05/02/2016
- Last Update Date: 03/05/2024
Medicare PECOS Information:
- PECOS PAC ID: 1052658903
- Enrollment ID: I20190130001770
Medical Identifiers
Medical identifiers for Altheresa Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1710332333 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101Y00000X | Counselor | SW13295 (Florida) | Secondary |
| 1041C0700X | Social Worker - Clinical | SW13295 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Altheresa Clark allows following entities to bill medicare on her behalf.
| Entity Name | Inspire4purpose, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1265954218
PECOS PAC ID: 3173942539
Enrollment ID: O20201005000230 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Altheresa Clark is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Altheresa Clark,
111 Nw 183rd St Ste 404,
Miami, FL 33169-4619
Ph: (786) 524-4001 | Altheresa Clark,
111 Nw 183rd St Ste 404,
Miami, FL 33169-4619
Ph: (786) 524-4001 |
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