CMS-1500 Box 24J / 33a • NPI
1366090573
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LF0000X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family
Box 32 Service Location & ZIP+4
2100 MADISON AVE, GRANITE CITY, IL, 62040-4713
✓ 9-Digit EDI 837 ZIP+4 (62040-4713)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1366090573 (DONALD LEE CLARK, FNP-BC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1366090573)
Medicare Beneficiaries
276
Total Billed Services
744
Distinct CPT/HCPCS Codes
13
Medicare Allowed Total
$83,884.25
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 205 |
99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 289 |
99236 | Initial hospital care with same-day admission and discharge with high level of medical decision making, per day, if using time, at least 85 minutes | 14 |
99239 | Hospital discharge day management, more than 30 minutes | 195 |
99284 | Emergency department visit with moderate level of medical decision making | 18 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Amoxicillin-Clavulanate Potass Amoxicillin/Potassium Clav | 14 | 14 |
| Cephalexin Cephalexin | 19 | 18 |
| Isosorbide Mononitrate Er Isosorbide Mononitrate | 11 | 11 |
| Levofloxacin Levofloxacin | 16 | 15 |
| Methylprednisolone Methylprednisolone | 12 | 12 |
| Potassium Chloride Potassium Chloride | 15 | <11 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1366090573 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | DONALD LEE CLARK, FNP-BC |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family NUCC Code: 363LF0000X (Nurse Practitioner, Family) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 2100 MADISON AVE, GRANITE CITY, IL, 62040-4713 |
| Practice Telephone / Fax | Tel: (618) 798-3000 |
| Administrative Mailing Address | 8308 BURLINGTON DR, TROY, IL, 62294-4003 |
| Enumeration & Last Sync | Enumerated: 2019-08-30 | CMS Record Updated: 2019-08-30 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LF0000X)
What Does Taxonomy Code 363LF0000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LF0000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (DONALD LEE CLARK, FNP-BC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: IL | License: 209019719 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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