Todd Clark, MEDICAL DOCTOR

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036-107180 Issued in IL

Practice address

1775 W Dempster St
1 West
Park Ridge, IL 60068-1143

Phone

(847) 723-5150

Fax

(847) 723-2083

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Advocate Health and Hospitals Corporation

  dba Advocate Medical Group

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  Medicare reassignment
• H Allen Hooper, M.D. a Professional Corporation

  dba Mission Emergency Medical Associates

  • Family Medicine Physician
  • Camarillo, CA
  • NPI 1205870540
  NPD (past)
• H. Allen Hooper, M.D. a Professional Corporation

  dba Mission Emergency Medical Associates

  • Emergency Medicine Physician
  • Oxnard, CA
  • NPI 1376575118
  NPD (past)
• Los Robles Emergency Physicians Medical Group

  • Emergency Medicine Physician
  • Thousand Oaks, CA
  • NPI 1417983552
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1073504767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731143",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 W DEMPSTER ST",
            "address_2": "1 WEST",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681143",
            "telephone_number": "847-723-5150",
            "fax_number": "847-723-2083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TODD",
        "credential": "MEDICAL DOCTOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A84896",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "CA",
            "license": "A84896",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "036-107180",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-107180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A84896",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A848960",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tclark206490@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1775 W Dempster St",
            "address_2": "1 West",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681143",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1775 W Dempster St",
            "address_2": "1 West",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lisa Ciszewski, LCPC
• Citrine Wellness Studio LLC
• City of Park Ridge
• Haley R Clark
• Laura Caitlin Clark
• Allison Hayes Clarke, PH.D.
• Catherine Melissa Claro, NP-BC
• Christina Classen, FNP
• Joanne Kristine Claveria, M.D.
• Rebecca Candler Clawson, MD

• Emergency Medicine Physician in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; 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.