Individual provider Active NPI

Caitlin S Clark, DO

  • Family Medicine Physician
  • Erie, PA
National Provider Identifier
1063490340
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS010364L Issued in PA
Practice address
311 W 24TH St Ste 305
Erie, PA 16502-2666
Phone
(814) 454-4484
Fax
(814) 452-1809
NPI assigned
Jan 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS010364L PA Primary

Addresses

Primary practice location

311 W 24TH St Ste 305
Erie, PA 16502-2666

Mailing address

311 W 24TH St Ste 305
Erie, PA 16502-2666
Phone (814) 454-4484

Other practice location 1

4247 W Ridge Rd Ste 105
Erie, PA 16506-1746
Phone (814) 838-2468

Other names 1

  • Caitlin Songey Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cclark148745@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20040105000112 PA Practitioner - Family Practice 9234038720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

311 W 24TH St
305 SV Family Medicine
Erie, PA 16502-2666
Phone (814) 454-4484

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.9 of 100Reported as apm
Quality
85.02
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS010364LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Medical Education and Research Institute Inc Family Medicine CurrentSince Aug 1, 2001 Accepting new patients
Saint Vincent Health Center Past Accepting new patients
Saint Vincent Medical Education and Research Institute Inc PastSince Aug 1, 2001 Accepting new patients
Saint Vincent Medical Education and Research Institute Family Medicine Past Accepting new patients

Locations

155 E State St
Albion, PA 16401
Phone (814) 756-4917

2314 Sassafras St
Ste 200
Erie, PA 16502
Phone (814) 452-4484

4247 W Ridge Rd
Ste 105
Erie, PA 16506
Phone (814) 453-7767

1910 Sassafras St
Ste 100
Erie, PA 16502
Phone (814) 452-5772

311 W 24th St
Ste 305
Erie, PA 16502
Phone (814) 454-4484

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1063490340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 W 24TH ST STE 305",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022666",
            "telephone_number": "814-454-4484",
            "fax_number": "814-452-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W 24TH ST STE 305",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022666",
            "telephone_number": "814-454-4484",
            "fax_number": "814-452-1809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4247 W Ridge Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165061746",
            "country_code": "US",
            "telephone_number": "814-838-2468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAITLIN",
        "middle_name": "S",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-06",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS010364L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cclark148745@direct.ahn.org",
            "affiliation": "N",
            "address_1": "4247 W Ridge Rd Ste 105",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165061746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CAITLIN",
            "last_name": "SONGEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.