Mark Andrew Clifford, MD
Individual provider Active NPI Psychiatry Physician · Fairbanks, AK
NPI 1003834086 · NPPES record last updated Feb 13, 2013
Key facts
- NPI
- 1003834086
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 13429 (HI)
- Practice address
- 122 1St Ave
Suite 600
Fairbanks, AK 99701-4803 - Phone
- (907) 750-4124
- Fax
- (808) 433-1558
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Georgetown University School of Medicine, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Tanana Chiefs Conference
Practice addresses (Care Compare)
122 1St Ave
Fairbanks, AK 99701-4871
Phone (907) 452-8251
1717 W Cowles St
Fairbanks, AK 99701-5926
Phone (907) 451-6682
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121003000883 | TX | Practitioner - Psychiatry |
5092964213 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13429 | HI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tanana Chiefs Conference | Current |
Accepting new patients | |
| Tanana Chiefs Conference | Current |
Accepting new patients |
Locations
122 1st Ave
Ste 600
Fairbanks, AK 99701
1717 W Cowles St
Fairbanks, AK 99701
Phone (907) 452-6682
Interoperability endpoints
- mark.clifford.2@15989.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 13429 | HI | |
| Psychiatry Physician | 2084P0800X | 13429 | HI | Yes |
Addresses
Primary practice location
122 1St Ave
Suite 600
Fairbanks, AK 99701-4803
Mailing address
122 1St Ave
Suite 600
Fairbanks, AK 99701-4803
Phone (907) 750-4124
Other providers in Fairbanks, AK
- Katherine Clawson
- Clear Vision Optometry, Inc
- Nicole Cleaver
- Alexis Elizabeth Clemente
- Samantha Fay Clemons
- Celina Marie Clift
- Alma Clifton
- Elizabeth Megan Cline
- Robbi Cline
- Lindsay Carolyn Clough
All providers in Fairbanks, AK · Psychiatry Physician in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.