Individual provider Active NPI

Cynthia Billmeyer Clark, MD

  • Emergency Medicine Physician
  • San Rafael, CA
National Provider Identifier
1144219767
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G53191 Issued in CA
Practice address
4000 Civic Center Dr
San Rafael, CA 94903-4171
Phone
(209) 342-2300
Fax
(209) 524-4240
NPI assigned
Oct 17, 2005
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G53191 CA Primary

Addresses

Primary practice location

4000 Civic Center Dr
San Rafael, CA 94903-4171

Mailing address

4301 Northstar Way
Modesto, CA 95356-9262
Phone (209) 342-2300

Other identifiers 2

IdentifierTypeStateIssuer
00G531910OtherCABCBS
00G531910MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040916000450 CA Practitioner - Emergency Medicine 0244207348 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G53191CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Emergency Medicine Current Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jan 1, 1987 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Jan 1, 1987 Accepting new patients

Locations

250 Bon Air Rd
Kentfield, CA 94904
Phone (415) 464-1350

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1144219767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 NORTHSTAR WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569262",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 CIVIC CENTER DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949034171",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CYNTHIA",
        "middle_name": "BILLMEYER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-17",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G53191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00G531910",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G531910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

Verify at the official NPI Registry.