Active NPI
Michael W Clark, DO
- Emergency Medicine Physician
- Saint Joseph, MI
National Provider Identifier
1073549804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 008264
- Practice address
- 1234 Napier Ave
Saint Joseph, MI 49085-2112 - Phone
- (269) 983-8300
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 008264 | MI | Primary |
Addresses
Primary practice location
1234 Napier Ave
Saint Joseph, MI 49085-2112
Mailing address
18828 N Fruitport Rd
Spring Lake, MI 49456-1160
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2580269 | Medicaid | MI | |
| 4742455 | Medicaid | MI | |
| 4742464 | Medicaid | MI | |
| MC008264 | Other | MI | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008264 | MI | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Urgent Care | Emergency Medicine | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296172800000",
"number": "1073549804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18828 N FRUITPORT RD",
"city": "SPRING LAKE",
"state": "MI",
"postal_code": "494561160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1234 NAPIER AVE",
"city": "SAINT JOSEPH",
"state": "MI",
"postal_code": "490852112",
"telephone_number": "269-983-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MICHAEL",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-23",
"last_updated": "2011-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "008264",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2580269",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4742455",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4742464",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "MC008264",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Joseph, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.