NPIMap

Organization Active NPI

Clark Integrated Medical Clinics LLC

  • General Practice Physician
  • Lafayette, LA
National Provider Identifier
1124529284
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CLARK INTEGRATED MEDICAL CLINICS LLC
Practice address
401 E Verot School Rd
Lafayette, LA 70508-3315
Phone
(337) 232-3353
Fax
(337) 232-9304
NPI assigned
Feb 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Authorized official

Name
Dr. Jacob Scott Clark, DCNPI 1003864620
Title
Owner
Phone
(337) 232-3353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

401 E Verot School Rd
Lafayette, LA 70508-3315

Mailing address

401 E Verot School Rd
Lafayette, LA 70508-3315
Phone (337) 232-3353

Other practice location 1

1833 E Main St
New Iberia, LA 70560-4045
Phone (337) 367-7463

Other practice location 2

1135 Expressway Dr Ste 100B
Pineville, LA 71360-6666
Phone (318) 793-7910

Other names 1

  • Clark Integrated Medical Clinics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180509000736 LA Part B Supplier - Clinic/Group Practice 8022372598 Receives reassigned benefits from 12 practitioners
Practice locations: Lafayette, LA; New Iberia, LA; Pineville, LA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2208766Clark Integrated Medical Clinics1833 East Main Street, New Iberia, LA 70560Certificate of waiverJan 7, 2027
19D2294028Clark Integrated Medical Clinics1135 Expressway Dr, Ste 100B, Pineville, LA 71360Certificate of waiverNov 16, 2027

National Provider Directory

National Provider Directory

Locations

130 Rue Beauregard
Ste A
Lafayette, LA 70508
Phone (337) 232-3353

1833 E Main St
New Iberia, LA 70560
Phone (337) 367-7463

1135 Expressway Dr
Ste 100B
Pineville, LA 71360
Phone (318) 487-6525

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1519344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753401600000",
    "number": "1124529284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E VEROT SCHOOL RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083315",
            "telephone_number": "337-232-3353",
            "fax_number": "337-232-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E VEROT SCHOOL RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083315",
            "telephone_number": "337-232-3353",
            "fax_number": "337-232-9304"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1833 E Main St",
            "address_purpose": "LOCATION",
            "city": "New Iberia",
            "state": "LA",
            "postal_code": "705604045",
            "country_code": "US",
            "telephone_number": "337-367-7463",
            "fax_number": "337-232-3353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1135 Expressway Dr Ste 100B",
            "address_purpose": "LOCATION",
            "city": "Pineville",
            "state": "LA",
            "postal_code": "713606666",
            "country_code": "US",
            "telephone_number": "318-793-7910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLARK INTEGRATED MEDICAL CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-23",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-232-3353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark Integrated Medical Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clark Integrated Medical Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2025; 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.