Timothy Michael Clark, CRNA in Tyler, TX - Medicare Certified Registered Nurse Anesthetist (crna)

Timothy Michael Clark, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Tyler, Texas. He graduated from nursing school in 2005 and has 19 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). He is a member of the group practice Mother Frances Hospital Regional Health Care Center and his current practice location is 800 E Dawson St, Tyler, Texas. You can reach out to his office (for appointments etc.) via phone at (903) 531-2668.

Timothy Michael Clark is licensed to practice in Texas (license number 074887) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1912017039.

Contact Information

	Timothy Michael Clark, CRNA
	800 E Dawson St, Tyler, TX 75701-2036
	(903) 531-2668
	Not Available

Map and Direction

Provider's Profile

Full Name	Timothy Michael Clark
Gender	Male
Speciality	Certified Registered Nurse Anesthetist (crna)
Experience	19 Years
Location	800 E Dawson St, Tyler, Texas
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Timothy Michael Clark graduated from nursing school in 2005

NPI Data:

NPI Number: 1912017039
Provider Enumeration Date: 08/30/2006
Last Update Date: 10/23/2017

Medicare PECOS Information:

PECOS PAC ID: 4486661303
Enrollment ID: I20060316000466

Medical Identifiers

Medical identifiers for Timothy Michael Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1912017039	NPI	-	NPPES
183309707	Medicaid	TX
75-0976930-005	Other	TX	TRICARE
P01877259	Other	TX	MEDICARE RAIL ROAD
183309702	Medicaid	TX
75-2771569-008	Other		TRICARE
183309703	Medicaid	TX
88839U	Other	TX	BCBS
138309701	Medicaid	TX
P01246269	Other	TX	RAIL ROAD
86167U	Other	TX	BCBS

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	074887 (Texas)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Christus Mother Frances Hospital	Tyler, TX	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Mother Frances Hospital Regional Health Care Center	9234025636	121

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. Timothy Michael Clark allows following entities to bill medicare on his behalf.

Entity Name	Mother Frances Hospital Jacksonville
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1952306672 PECOS PAC ID: 5597751024 Enrollment ID: O20040421001092

Entity Name	Christus Good Shepherd Medical Center
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1760908404 PECOS PAC ID: 3779565544 Enrollment ID: O20040604000400

Entity Name	Mother Frances Hospital Regional Health Care Center
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1679578439 PECOS PAC ID: 9234025636 Enrollment ID: O20040610001042

Entity Name	Eye Surgery Center Of East Texas Pllc
Entity Type	Part B Supplier - Ambulatory Surgical Center
Entity Identifiers	NPI Number: 1396266441 PECOS PAC ID: 6406112861 Enrollment ID: O20171117001804

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. Timothy Michael 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
Timothy Michael Clark, CRNA Po Box 841656, Dallas, TX 75284-1656 Ph: (903) 531-4522	Timothy Michael Clark, CRNA 800 E Dawson St, Tyler, TX 75701-2036 Ph: (903) 531-2668

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Tyler, TX

Mrs. Glenda R Sealey, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 1424 East Front, Tyler, TX 75702 Phone: 903-595-4144 Fax: 903-596-7541
John Glynn Jeansonne, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 S Beckham Ave, Tyler, TX 75701 Phone: 903-526-1068 Fax: 903-593-4290
Jeffrey Manglicmot, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 800 E Dawson St, Tyler, TX 75701 Phone: 903-531-4522
Harold Richie Bandalan, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 S Beckham Ave, Tyler, TX 75701 Phone: 903-526-1068 Fax: 903-593-4290
Jeffrey David Barker, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 S Beckham Ave, Tyler, TX 75701 Phone: 903-597-0351
Gregory Mallett, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 800 E Dawson St, Tyler, TX 75701 Phone: 903-606-4522
Cara L Dewolfe, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 800 E Dawson St, Tyler, TX 75701 Phone: 903-593-8441

Timothy Michael Clark, CRNA - Medicare Certified Registered Nurse Anesthetist (crna) in Tyler, TX