Clark Clinic Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

CLARK CLINIC INC

Practice address

12620 Curley St
San Antonio, FL 33576-8136

Phone

(352) 787-1600

NPI assigned

Feb 19, 2020

Organization subpart

No

Name

Lowell F. ClarkNPI 1336103563

Title

Owner

Phone

(352) 793-2441

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Lowell F. Clark, M.D.

  • Internal Medicine Physician
  • Bushnell, FL
  • NPI 1336103563

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Clark Clinic Inc

  • Rural Health Clinic/Center
  • Bushnell, FL
  • NPI 1376733857

  1759278203

  Same PAC ID
• Clark Clinic Inc

  • Rural Health Clinic/Center
  • Howey in the Hills, FL
  • NPI 1467642942

  1759278203

  Same PAC ID
• Clark Clinic Inc

  • Rural Health Clinic/Center
  • Mascotte, FL
  • NPI 1639693492

  1759278203

  Same PAC ID

Organizations that report the same tax identification number in the National Provider Directory.

• Clark Clinic Inc

  • Internal Medicine Physician
  • Oxford, FL
  • NPI 1134873011
  NPD tax ID
• Clark Clinic Inc

  • Clinic/Center
  • Sorrento, FL
  • NPI 1225661481
  NPD tax ID
• Clark Clinic Inc

  • Rural Health Clinic/Center
  • Bushnell, FL
  • NPI 1376733857
  NPD tax ID
• Clark Clinic Inc

  • Rural Health Clinic/Center
  • Howey in the Hills, FL
  • NPI 1467642942
  NPD tax ID
• Clark Clinic Inc

  • Rural Health Clinic/Center
  • Mascotte, FL
  • NPI 1639693492
  NPD tax ID
• Clark Clinic Inc

  • Clinic/Center
  • Altoona, FL
  • NPI 1992338156
  NPD tax ID

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lowell F. Clark, M.D.

  • Internal Medicine Physician
  • Bushnell, FL
  • NPI 1336103563
  NPD (past) Authorized official

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in FL

Legal name

CLARK CLINIC INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 3, 2024

Last certification

Sep 3, 2024

Ownership / control type

1A

Organization structure

CorporationProprietary

Incorporated

Oct 9, 2002 in FL

Enrollment address

12620 Curley St
Unit 103;104
San Antonio, FL 33576

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Tax ID family

Clark Clinic Inc (7 organizations share this tax ID)

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 19, 2020.

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1013540947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S FLORIDA ST",
            "city": "BUSHNELL",
            "state": "FL",
            "postal_code": "335136703",
            "telephone_number": "352-793-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12620 CURLEY ST",
            "city": "SAN ANTONIO",
            "state": "FL",
            "postal_code": "335768136",
            "telephone_number": "352-787-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LOWELL",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-793-2441"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Elizabeth Becker, RDN, LDN
• Christine M Berry, BCHHP
• Danielle Blommel
• Kenzie Nicole Brummett, APRN, FNP-C
• Gail Sandra Castro, L.C.S.W., M.S.W.
• Mackenzie Rae Coleman, PHARMD
• Comfortable Care Dental Health Professionals, P.a.
• Comfortable Care Dental Health Professionals, P.a.
• Community Victory Family Services, Inc.
• James Andrew Dapello

• All providers in San Antonio, FL
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.