Individual provider Active NPI

Sarah L Clark, PH.D.

  • Clinical Psychologist
  • Worthington, Oh, OH
National Provider Identifier
1053362533
Registry record updated Jan 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
5484 Issued in OH
Practice address
500 W Wilson Bridge Rd
Ste 30
Worthington, Oh, OH 43085-2288
Phone
(614) 560-3995
NPI assigned
May 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 5484 OH Primary

Addresses

Primary practice location

500 W Wilson Bridge Rd
Ste 30
Worthington, Oh, OH 43085-2288

Mailing address

500 W Wilson Bridge Rd
Ste 30
Worthington, Oh, OH 43085-2288
Phone (614) 560-3995

Other identifiers 1

IdentifierTypeStateIssuer
2375513MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110411000098 OH Practitioner - Clinical Psychologist 5395929723 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lewis and Evans LLCGroup PAC ID 1557600251, 6 clinicians

Practice addresses (Care Compare)

165 Highbluffs Blvd
Columbus, OH 43235-1484
Phone (614) 846-6076

6457 Reflections Dr
Suite 120
Dublin, OH 43017-2352
Phone (614) 792-1108

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5484OHMDClinical Psychologist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548460800000",
    "number": "1053362533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W WILSON BRIDGE RD",
            "address_2": "STE 30",
            "city": "WORTHINGTON, OH",
            "state": "OH",
            "postal_code": "430852288",
            "telephone_number": "614-560-3995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W WILSON BRIDGE RD",
            "address_2": "STE 30",
            "city": "WORTHINGTON, OH",
            "state": "OH",
            "postal_code": "430852288",
            "telephone_number": "614-560-3995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SARAH",
        "middle_name": "L",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2019-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "5484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2375513",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.