NPIMap

Individual provider Active NPI

Christopher C Clark, DO

  • Family Medicine Physician
  • Erie, PA
National Provider Identifier
1093793341
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS009560L Issued in PA
Practice address
311 W 24TH St Ste 305
Erie, PA 16502-2666
Phone
(814) 454-4484
NPI assigned
Jan 6, 2006
Last updated
Oct 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 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 OS009560L 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

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cclark148746@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20040107000699 PA Practitioner - Family Practice 2567361603 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1996
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

Merit-based Incentive Payment System (MIPS)

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

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Erie Medical Group PC Family Medicine Current Accepting new patients
Westfield Memorial Hospital, Inc. Current Accepting new patients
Westfield Memorial Hospital, Inc. Current Accepting new patients
Saint Vincent Medical Education and Research Institute Inc PastSince May 27, 2016 Accepting new patients
Saint Vincent Medical Education and Research Institute Family Medicine Past Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: cclark148746@direct.ahn.org

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Saint Vincent HospitalErie, PA, CCN 390009 Hospital Corporate Officer Jun 5, 2017
Saint Vincent HospitalErie, PA, CCN 39T009 Hospital Corporate Officer
W-2 Managing Employee		 Jun 5, 2017
Jun 5, 2017
Grove City Medical CenterGrove City, PA, CCN 390266 Hospital Corporate Officer Jan 1, 2024
Saint Vincent HospitalErie, PA, CCN 39S009 Hospital Corporate Officer Jun 5, 2017
Westfield Memorial Hospital IncWestfield, NY, CCN 330801 Hospital Corporate Officer Jan 1, 2025
Visiting Nurse Association of Erie CountyErie, PA, CCN 397034 Home health agency Corporate Director Nov 1, 2017
Saint Vincent Medical GroupCorry, PA, CCN 393889 Rural health clinic Corporate Director Jan 1, 2023

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

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": "1601596800000",
    "number": "1093793341",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS009560L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cclark148746@direct.ahn.org",
            "affiliation": "N",
            "address_1": "311 W 24th St Ste 305",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165022666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.