TERRI MARIE CLACK (PMHNP-BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1487169173
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,971 NURSE PRACTITIONER in MA
Provider Addresses for TERRI MARIE CLACK (PMHNP-BC)
1 WASHINGTON MALL STE 1045
BOSTON, MA 021082603
Phone: (617) 249-4036
Fax: (617) 843-9320
Type: Mailing
169 Libbey Industrial Pkwy
Weymouth, MA 021893189
Phone: (781) 551-0999
Type: Location
2550 AKERS MILL RD SE APT C26
ATLANTA, GA 303393211
Phone: (716) 812-0736
Type: Mailing
169 LIBBEY PKWY
WEYMOUTH, MA 021893189
Phone: (781) 474-5287
Type: Mailing
169 LIBBEY INDUSTRIAL PKWY
WEYMOUTH, MA 021893189
Phone: (781) 551-0999
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2022-12-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20180825000126 | I | Nurse Practitioner | GA | TBD |
| I20221207000920 | I | Nurse Practitioner | MA | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 02108)
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