NPIMap

Individual provider Active NPI

Richard R. Clark, M.D.

  • Family Medicine Physician
  • Grayslake, IL
National Provider Identifier
1023042470
Registry record updated Jan 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
003-036-082187-01 Issued in IL
Practice address
1475 E Belvidere Rd Unit 385
Grayslake, IL 60030-2026
Phone
(847) 535-8000
NPI assigned
Jul 10, 2006
Last updated
Jan 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 38607 WI
Family Medicine Physician 207Q00000X 003-036-082187-01 IL Primary

Addresses

Primary practice location

1475 E Belvidere Rd Unit 385
Grayslake, IL 60030-2026

Mailing address

1475 E Belvidere Rd Unit 385
Grayslake, IL 60030-2026
Phone (847) 535-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190213000620 IL Practitioner - Family Practice 0143130203 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6155 Grand Ave
Suite 200
Gurnee, IL 60031-1651
Phone (847) 535-7157

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
003-036-082187-01ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Apr 23, 2023 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Apr 23, 2023 Accepting new patients
Central Dupage Physician Group Family Medicine Past Accepting new patients
Ascension All Saints Hospital, Inc PastSince Jun 17, 2003 Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

1475 E Belvidere Rd
Unit 385
Grayslake, IL 60030
Phone (312) 694-0484

6155 Grand Ave
Ste 200
Gurnee, IL 60031

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547251200000",
    "number": "1023042470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 E BELVIDERE RD UNIT 385",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302026",
            "telephone_number": "847-535-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 E BELVIDERE RD UNIT 385",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302026",
            "telephone_number": "847-535-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RICHARD",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2019-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "38607",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "003-036-082187-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, IL

Sources for this page

Verify at the official NPI Registry.