NPIMap

Individual provider Active NPI

Steven Lester Clark, MD

  • Family Medicine Physician
  • Niceville, FL
National Provider Identifier
1124125505
Registry record updated Jun 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME88544 Issued in FL
Practice address
4586 E Highway 20
Suite B
Niceville, FL 32578-9724
Phone
(850) 897-3200
Fax
(850) 897-2353
NPI assigned
Sep 20, 2006
Last updated
Jun 8, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2011

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 ME88544 FL Primary

Addresses

Primary practice location

4586 E Highway 20
Suite B
Niceville, FL 32578-9724

Mailing address

PO Box 2699
Pensacola, FL 32513-2699
Phone (850) 897-3200

Other identifiers 1

IdentifierTypeStateIssuer
002577400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20110323000492 FL Practitioner - Family Practice 4587847934 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Uniformed Services Uhs Fe Hebert School of Med, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventhealth Primary Care Network IncGroup PAC ID 1557722410, 428 clinicians

Practice addresses (Care Compare)

1 Memorial Medical Pkwy
Palm Coast, FL 32164-5979

661 E Altamonte Dr
Suite 115
Altamonte Springs, FL 32701-5102
Phone (407) 831-4040

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME88544FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventhealth Primary Care Network Inc Family Medicine CurrentSince Nov 1, 2023 Accepting new patients
Tri Hospital MRI Center Past Accepting new patients

Locations

661 E Altamonte Dr
Ste 115
Altamonte Springs, FL 32701
Phone (407) 831-4040

Interoperability endpoints

  • Direct secure messaging: sclark1009423@adventhealth.direct-ci.com
  • Direct secure messaging: steven.clark.2@9582.direct.athenahealth.com

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.

Hospital & facility affiliations 8

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307491200000",
    "number": "1124125505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325132699",
            "telephone_number": "850-897-3200",
            "fax_number": "850-897-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4586 E HIGHWAY 20",
            "address_2": "SUITE B",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325789724",
            "telephone_number": "850-897-3200",
            "fax_number": "850-897-2353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEVEN",
        "middle_name": "LESTER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME88544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002577400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

Verify at the official NPI Registry.