MRS. KOLU S. BAYSAH CLARK (DNP) – Gerontology Nurse Practitioner, NPI 1336535624
Gerontology Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
1,476 NURSE PRACTITIONER in RI
Provider Addresses for MRS. KOLU S. BAYSAH CLARK (DNP)
593 Eddy St
Providence, RI 029034923
Phone: (401) 793-9166
Fax: (401) 444-2788
Type: Location
149 POMONA AVE
PROVIDENCE, RI 029085123
Phone: (401) 585-5864
Type: Mailing
1 HARVARD RD
SHIRLEY, MA 014642434
Phone: (978) 425-4341
Type: Location
455 TOLLGATE RD
PROFESSIONAL REVENUE CYCLE AND CREDENTIALING
WARWICK, RI 028862759
Phone: (401) 273-0641
Fax: (401) 273-2919
Type: Mailing
455 TOLL GATE RD
WARWICK, RI 028862759
Phone: (401) 737-7010
Type: Location
1 Harvard Rd
Shirley, MA 014642434
Phone: (978) 425-4341
Type: Location
55 Lake Ave N
Worcester, MA 016550002
Phone: (508) 334-8515
Fax: (508) 334-6490
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: 2021-01-26
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 |
|---|---|---|---|---|
| I20210126003036 | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 13 | 13 | $0 |
Insurance plans in this area (ZIP 02903)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | MA | |
| - | MA | |
| - | MA | |
| Family Practice | MA | |
| Physician Assistant | MA | |
| Pulmonary Disease, Critical Care (Intensivists), Allergy/Immunology | MA | |
| - | MA | |
| - | MA | |
| Internal Medicine | MA | |
| Nurse Practitioner | MA |
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