COTENNA D. CLARK – Gerontology Nurse Practitioner, NPI 1801401112
Gerontology Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,652 NURSE PRACTITIONER in GA
Provider Addresses for COTENNA D. CLARK
1857 CAMEO CT
TUCKER, GA 300847002
Phone: (678) 485-1156
Type: Mailing
57 EXECUTIVE PARK SOUTH NE
ATLANTA, GA 303292288
Phone: (404) 712-6929
Fax: (404) 712-0278
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $117.
Total Amount is formed as General ($117) + Research ($0) + Ownership ($0) = $117.
Last reported payment date: 2023-09-29 • Largest payer in this snapshot: Eisai Inc. ($117).
Total Amount
$117
General + Research + Ownership
Payments
1
Total payment records
General Amount
$117
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-09-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Eisai Inc. | $117 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-01-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20220112001743 | I | Nurse Practitioner | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 55 | 21 | $0 |
| 99350 | Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes | 49 | 24 | $0 |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 37 | 24 | $0 |
| 99487 | Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month | 35 | 18 | $0 |
| 99489 | Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month | 26 | 12 | $0 |
Insurance plans in this area (ZIP 30084)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal Medicine | CA | |
| Internal Medicine | GA | |
| Physician Assistant | FL | |
| Interventional Radiology, Diagnostic Radiology | KY | |
| Anesthesiology Assistant | GA | |
| - | CA | |
| D E R M A T O L O G Y | GA | |
| Interventional Radiology, Diagnostic Radiology | NC | |
| Physician Assistant | GA | |
| - | GA |
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