Individual provider Active NPI

Taylor Clark, PA-C

  • Physician Assistant
  • Huntsville, AL
National Provider Identifier
1114578994
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.1526 Issued in AL
Practice address
4715 Whitesburg Dr SE
Huntsville, AL 35802-1632
Phone
(256) 881-5151
NPI assigned
Sep 24, 2019
Last updated
May 18, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0006959 CO
Physician Assistant 363A00000X PA.1526 AL Primary

Addresses

Primary practice location

4715 Whitesburg Dr SE
Huntsville, AL 35802-1632

Mailing address

4715 Whitesburg Dr SE
Huntsville, AL 35802-1632

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, AZ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200411000722 AL Practitioner - Physician Assistant 9335578491 Reassigns benefits to 1 organization
I20230927001946 AZ Practitioner - Physician Assistant 9335578491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sportsmed Orthopaedic SpecialistsGroup PAC ID 7214903723, 87 clinicians

Practice addresses (Care Compare)

4715 Whitesburg Dr S
Huntsville, AL 35802-1632

4715 Whitesburg Dr SE
Huntsville, AL 35802-1632

4715 Whitesburg Dr SE
Huntsville, AL 35802-1649
Phone (256) 881-5151

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.66 of 100Reported as group
Quality
90
Promoting interoperability
94
Improvement activities
40
Cost
80.55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.1526ALMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sportsmed Orthopaedic Specialists CurrentSince Feb 26, 2020 Accepting new patients
Sportsmed Orthopaedic Specialists, PC CurrentSince Feb 26, 2020 Accepting new patients
Camelback Pain PLLC PastSince Oct 5, 2025 Accepting new patients

Locations

4715 Whitesburg Dr SE
Huntsville, AL 35802
Phone (256) 319-8500

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1114578994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4715 WHITESBURG DR SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358021632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 WHITESBURG DR SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358021632",
            "telephone_number": "256-881-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TAYLOR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-24",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006959",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.1526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.