G Renee Thomas-Clark, DO

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

OS015338 Issued in PA

Practice address

4740 Peach St
Erie, PA 16509-2008

Phone

(814) 454-3174

Fax

(814) 616-8002

NPI assigned

Jan 17, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Medical Associates of Erie

  dba Primary Care at the Achievement Center

  • Family Medicine Physician
  • Erie, PA
  • NPI 1164304903
  NPD
• Medical Associates of Erie

  • Family Medicine Physician
  • Erie, PA
  • NPI 1215055769
  NPD
• Medical Associates of Erie

  • Internal Medicine Physician
  • Erie, PA
  • NPI 1649205816
  NPD
• Millcreek Community Hospital

  dba LECOM Health Millcreek Medical Arts

  • Family Medicine Physician
  • Erie, PA
  • NPI 1053198382
  NPD
• Millcreek Community Hospital

  • Psychiatry Physician
  • Erie, PA
  • NPI 1245865815
  NPD

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1043362320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LECOM PL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165052571",
            "telephone_number": "814-868-2529",
            "fax_number": "814-868-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092008",
            "telephone_number": "814-454-3174",
            "fax_number": "814-616-8002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "537 W 18th St",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165021722",
            "country_code": "US",
            "telephone_number": "814-454-3174",
            "fax_number": "814-616-8002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS-CLARK",
        "first_name": "G",
        "middle_name": "RENEE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PA",
            "license": "OS015338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Thide
• Margrethe Thiesen
• Edward Alfred Thiry III, LSW, CAC
• Thomas F. Matta, PH.D., Inc.
• Thomas R Masters DO
• Anna Thomas, PHDHP
• Cecil Veloor Thomas, D.O.
• Donna Thomas
• James Joseph Thomas Jr., MD
• Jeremy Thomas, ATC, DPT

• Child & Adolescent Psychiatry Physician in Erie, PA
• Providers in Erie, PA by specialty
• Child & Adolescent Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; 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.