Active NPI
Kristine J. Clark, O.T.C.
- Other Specialist/Technologist
- Appleton, WI
National Provider Identifier
1073795506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- Practice address
- Valley Orthopedic Clinic SC
2105 E Enterprise Ave., Ste 111
Appleton, WI 54913-7862 - Phone
- (920) 731-6611
- Fax
- (920) 731-6732
- NPI assigned
- Nov 27, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Other Specialist/Technologist | 246Z00000X | Primary |
Addresses
Primary practice location
Valley Orthopedic Clinic SC
2105 E Enterprise Ave., Ste 111
Appleton, WI 54913-7862
Mailing address
Valley Orthopedic Clinic SC
2105 E Enterprise Ave., Ste 111
Appleton, WI 54913-7862
Phone (920) 731-6611
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06-0813 | Other | ORTHOPAEDIC TECH-CERT |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Orthopedic Clinic SC | Past | Accepting new patients | |
| Orthopedic and Sports Institute of the Fox Valley S C | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EBJABD
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.
-
dba Orthopedic Clinic of Appleton
- Orthopaedic Surgery Physician
- Appleton, WI
- NPI 1003836867
-
- Multi-Specialty Clinic/Center
- Appleton, WI
- NPI 1780628925
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196121600000",
"number": "1073795506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "VALLEY ORTHOPEDIC CLINIC SC",
"address_2": "2105 E ENTERPRISE AVE., STE 111",
"city": "APPLETON",
"state": "WI",
"postal_code": "549137862",
"telephone_number": "920-731-6611",
"fax_number": "920-731-6732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "VALLEY ORTHOPEDIC CLINIC SC",
"address_2": "2105 E ENTERPRISE AVE., STE 111",
"city": "APPLETON",
"state": "WI",
"postal_code": "549137862",
"telephone_number": "920-731-6611",
"fax_number": "920-731-6732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KRISTINE",
"middle_name": "J.",
"name_prefix": "Mrs.",
"credential": "O.T.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-27",
"last_updated": "2007-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ORTHOPAEDIC TECH-CERT",
"identifier": "06-0813",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.