NPIMap

Individual provider Active NPI

Chelsea Clark

  • Emergency Medicine Physician
  • Corpus Christi, TX
National Provider Identifier
1063097046
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
V3265 Issued in TX
Practice address
3902 Cimarron Blvd Apt 10204
Corpus Christi, TX 78414-4291
Phone
(512) 293-3641
NPI assigned
Mar 11, 2021
Last updated
Oct 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X V3265 TX Primary

Addresses

Primary practice location

3902 Cimarron Blvd Apt 10204
Corpus Christi, TX 78414-4291

Mailing address

3902 Cimarron Blvd Apt 10204
Corpus Christi, TX 78414-4291
Phone (512) 293-3641

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address chelseaclark@my.unthsc.edu Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20241031001721 TX Practitioner - Emergency Medicine 9739612573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comal Emergency Physicians PLLCGroup PAC ID 6901259936, 81 clinicians
Gulf Coast Emergency Physicians, PLLCGroup PAC ID 6204280480, 108 clinicians

Practice addresses (Care Compare)

1301 Wonder World Dr
San Marcos, TX 78666-7533
Phone (512) 353-8979

1311 E Gen Cvazos Blvd
Kingsville, TX 78363-7150
Phone (361) 595-1661

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
V3265TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Emergency Physicians, PLLC Emergency Medicine CurrentSince Sep 20, 2024 Accepting new patients

Locations

200 Corporate Blvd
Lafayette, LA 70508

2500 E Main St
Alice, TX 78332
Phone (361) 664-4376

600 Elizabeth St
Corpus Christi, TX 78404
Phone (361) 325-2511

1311 Gen Cvazos Blvd
Kingsville, TX 78363
Phone (361) 595-1661

Organizations & group practices 2

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 5

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": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1063097046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 CIMARRON BLVD APT 10204",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784144291",
            "telephone_number": "512-293-3641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 CIMARRON BLVD APT 10204",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784144291",
            "telephone_number": "512-293-3641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHELSEA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-11",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "V3265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "chelseaclark@my.unthsc.edu",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Personal",
            "address_1": "3902 Cimarron Blvd Apt 10204",
            "city": "Corpus Christi",
            "state": "TX",
            "country_code": "US",
            "postal_code": "784144291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corpus Christi, TX

Sources for this page

Verify at the official NPI Registry.