Active NPI
Brianna Clark, PT
- Physical Therapist
- West Lafayette, IN
National Provider Identifier
1043198344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- CP053478T
- Practice address
- 2548 Cumberland Ave Ste 100
West Lafayette, IN 47906-4083 - Phone
- (317) 802-2000
- Fax
- (317) 802-2050
- NPI assigned
- Aug 25, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | CP048794T | TN | |
| Physical Therapist | 225100000X | 05016133A | IN | |
| Physical Therapist | 225100000X | CP053478T | SC | Primary |
| Physical Therapist | 225100000X | 16812 | TN |
Addresses
Primary practice location
2548 Cumberland Ave Ste 100
West Lafayette, IN 47906-4083
Mailing address
12788 Touchdown Dr
Fishers, IN 46037-9532
Phone (317) 544-8926
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | brianna.clark.1@29985.direct.athenahealth.com | Orthopaedics-Indianapolis, Inc |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260317002018 | SC | Practitioner - Physical Therapist in Private Practice | 5092298166 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Orthosc LLC
Practice addresses (Care Compare)
103 Professional Park Dr
Conway, SC 29526-9261
Phone (843) 353-3460
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05016133A | IN | MD | Physical Therapist |
| CP053478T | SC | MD | Physical Therapist |
| CP048794T | TN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthosc, LLC | Current | Accepting new patients | |
| Orthosc, LLC | Current | Accepting new patients |
Locations
103 Professional Park Dr
Conway, SC 29526
Phone (843) 335-3346
210 Village Center Blvd
Ste 100
Myrtle Beach, SC 29579
Phone (843) 491-4937
Interoperability endpoints
- https://api.platform.athenahealth.com/17161/brand/1/csg/1/fhir/r4
Organizations & group practices 6
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- Conway, SC
- NPI 1275369787
-
- Orthopaedic Surgery Physician
- Myrtle Beach, SC
- NPI 1174139919
-
- Orthopaedic Surgery Physician
- Myrtle Beach, SC
- NPI 1306347257
-
- Orthopaedic Surgery Physician
- Conway, SC
- NPI 1669973517
-
- Orthopaedic Surgery Physician
- North Myrtle Beach, SC
- NPI 1568100691
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784678400000",
"number": "1043198344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12788 TOUCHDOWN DR",
"city": "FISHERS",
"state": "IN",
"postal_code": "460379532",
"telephone_number": "317-544-8926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2548 CUMBERLAND AVE STE 100",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479064083",
"telephone_number": "317-802-2000",
"fax_number": "317-802-2050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRIANNA",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-08-25",
"last_updated": "2026-07-22",
"certification_date": "2026-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "CP048794T",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05016133A",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "CP053478T",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "16812",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "brianna.clark.1@29985.direct.athenahealth.com",
"affiliation": "Y",
"endpointDescription": "Athena Address",
"affiliationName": "Orthopaedics-Indianapolis, Inc",
"address_1": "2548 Cumberland Ave Ste 100",
"city": "West Lafayette",
"state": "IN",
"country_code": "US",
"postal_code": "479064083",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.