Individual provider Active NPI

Ellen G I Clark, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Reno, NV
National Provider Identifier
1114960267
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
5850 Issued in NV
Practice address
77 Pringle Way
Washoe Medical Center
Reno, NV 89502
Phone
(775) 334-3450
Fax
(775) 334-3417
NPI assigned
Jun 14, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X G9334 TX
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X A46175 CA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 5850 NV Primary

Addresses

Primary practice location

77 Pringle Way
Washoe Medical Center
Reno, NV 89502

Mailing address

PO Box 3947
Reno, NV 89505-3947
Phone (775) 334-3450

Other identifiers 1

IdentifierTypeStateIssuer
XPY144620MedicaidCA

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 Medicine

State licenses

LicenseStateTypeSpecialty
A46175CAMDAnatomic Pathology & Clinical Pathology Physician
G9334TXMDAnatomic Pathology & Clinical Pathology Physician

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1114960267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3947",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895053947",
            "telephone_number": "775-334-3450",
            "fax_number": "775-334-3417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 PRINGLE WAY",
            "address_2": "WASHOE MEDICAL CENTER",
            "city": "RENO",
            "state": "NV",
            "postal_code": "89502",
            "telephone_number": "775-334-3450",
            "fax_number": "775-334-3417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELLEN",
        "middle_name": "G I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "G9334",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A46175",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NV",
            "license": "5850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XPY144620",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.