Brendon Matthew Clark

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05015804A Issued in IN

Practice address

5265 E 82ND St Ste 200
Indianapolis, IN 46250-1627

Phone

(317) 542-3723

NPI assigned

Feb 12, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Athletico LTD

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028

  IN

  Medicare reassignment Care Compare group NPD
• Athletico LTD

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Physical Therapist

  NPD

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

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1114483336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8127 HEATHERY PL",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462142280",
            "telephone_number": "317-246-7549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5265 E 82ND ST STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501627",
            "telephone_number": "317-542-3723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8127 Heathery Pl",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462142280",
            "country_code": "US",
            "telephone_number": "317-246-7549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRENDON",
        "middle_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-12",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05015804A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Kay Clark, OTR
• Bradley A Clark, D.O.
• Brandon Clark
• Brandon Clark, NP
• Brenda Belden Clark, PHARMD
• Brittney Le'Shai Clark
• Cameron Clark, RBT
• Carol Clark, CNP
• Charles Malcolm Clark Jr., MD
• Cherie Clark, M.A.

• Physical Therapist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.