Cassidy Leigh Clark, DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5151017360 Issued in MI

Practice address

100 Michigan St NE Ste A601
Grand Rapids, MI 49503-2560

Phone

(616) 391-6243

NPI assigned

Apr 7, 2025

Last updated

Jun 18, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Interoperability endpoints

• Direct secure messaging: cclark4404989@direct.trinity-health.org

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

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1023802725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE STE A601",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE STE A601",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-6243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CASSIDY",
        "middle_name": "LEIGH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-07",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5151017360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Thomas Clark, PT, DPT, OCS, COMT
• Alysa Michelle Clark, MD
• Amanda Elizabeth Clark, BS, QIDP
• Austin J Clark, PA
• Carrie Hoogerhyde Clark, DO
• Chelsea Clark, LCSW
• Christopher D Clark, MD
• Colton L Clark
• Emma Clark
• Eve Clark

• Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.