MRS. ELISE DIANE CLARK (FNP BC) – Nurse Practitioner, NPI 1184619595
Nurse Practitioner
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
14,984 NURSE PRACTITIONER in OH
Provider Addresses for MRS. ELISE DIANE CLARK (FNP BC)
2875 W Elm St
Lima, OH 458052510
Phone: (419) 991-7805
Fax: (419) 991-7862
Type: Location
607 ELIDA AVE
DELPHOS, OH 458331736
Phone: (419) 991-7805
Type: Location
West Elm Street, Lima, Allen County, Ohio, 45807, United States
LIMA, OH 458052510
Phone: (419) 991-7805
Fax: (419) 991-7862
Type: Mailing
1001 BELLEFONTAINE AVE
LIMA, OH 458042800
Phone:
Type: Mailing
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: 2005-09-19
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 |
|---|---|---|---|---|
| I20050919000889 | I | Nurse Practitioner | OH | 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 |
|---|---|---|---|---|
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 119 | 119 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 76 | 61 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 45 | 37 | $0 |
| 99442 | Telephone medical discussion with physician, 11-20 minutes | 35 | 30 | $0 |
Insurance plans in this area (ZIP 45805)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| NURSE PRACTITIONER | OH | 81002 | Urinalysis, manual test | 38 | 31 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OH | |
| Family Practice | OH |
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