Lea L Clark, is a medicare enrolled "Nurse Practitioner - Family" in Yates City, Illinois. She graduated from nursing school in 2020 and has 4 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice St Mary Medical Center and her current practice location is
717 Knox County Highway 18, Yates City, Illinois. You can reach out to her office (for appointments etc.) via phone at
(309) 264-2457.
Lea L Clark is licensed to practice in Illinois (license number 209021458) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1255910386.
Provider's Profile
| Full Name | Lea L Clark |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 4 Years |
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| Location | 717 Knox County Highway 18, Yates City, Illinois |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Lea L Clark graduated from nursing school in 2020
NPI Data:
- NPI Number: 1255910386
- Provider Enumeration Date: 04/06/2021
- Last Update Date: 09/30/2021
Medicare PECOS Information:
- PECOS PAC ID: 6204234982
- Enrollment ID: I20211011001242
Medical Identifiers
Medical identifiers for Lea L Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1255910386 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | 209021458 (Illinois) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 209021458 (Illinois) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| St Mary Medical Center | 8628038015 | 43 |
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. Lea L Clark allows following entities to bill medicare on her behalf.
| Entity Name | Knox Clinic Corp |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1265481006
PECOS PAC ID: 6305813411
Enrollment ID: O20040916000542 |
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| Entity Name | St Mary Medical Center |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1962467670
PECOS PAC ID: 8628038015
Enrollment ID: O20041011000420 |
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| Entity Name | Osf Multi-specialty Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1922445527
PECOS PAC ID: 3678889789
Enrollment ID: O20150904000279 |
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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. Lea L 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 |
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Lea L Clark,
834 N Seminary St, Ste 201,
Galesburg, IL 61401-2898
Ph: (309) 343-7195 | Lea L Clark,
717 Knox County Highway 18,
Yates City, IL 61572
Ph: (309) 264-2457 |
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