Michelle Olivette Clark, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A 31665 Issued in CA

Practice address

1005 Atlantic Ave
Alameda, CA 94501-1148

Phone

(415) 474-7310

NPI assigned

Mar 3, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Felton Institute

  • Community/Behavioral Health Agency
  • Alameda, CA
  • NPI 1144551581
  Medicare reassignment NPD
• Felton Institute

  • Community/Behavioral Health Agency
  • Oakland, CA
  • NPI 1124535570
  NPD
• Felton Institute

  • Community/Behavioral Health Agency
  • San Mateo, CA
  • NPI 1417222084
  NPD (past)
• Felton Institute

  • Community/Behavioral Health Agency
  • San Francisco, CA
  • NPI 1578771119
  NPD (past)
• Traditions Psychiatry Group, P.C

  • Psychiatry Physician
  • Santa Rosa, CA
  • NPI 1083802979
  NPD (past)

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

{
    "created_epoch": "1172880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1164551545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 REDWOOD RD STE 20A-522",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946192363",
            "telephone_number": "510-842-8960",
            "fax_number": "105-842-8983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 ATLANTIC AVE",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945011148",
            "telephone_number": "415-474-7310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 Redwood Rd Ste 20A-522",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946192363",
            "country_code": "US",
            "telephone_number": "510-842-8960",
            "fax_number": "510-843-8983",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHELLE",
        "middle_name": "OLIVETTE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-03",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A 31665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "A 31665",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Alameda Health Care District
• Jennifer Clara-Estrada
• Claremont Behavioral Services
• Janelle Veronica Clark
• Jason Robert Clark
• William Blackmore Claussen, DDS
• Arthur Clinton
• Jennifer Nayeli Cloer
• Coast Guard Headquarters
• Codependency Psychotherapy Clinic

• Psychiatry Physician in Alameda, CA
• Providers in Alameda, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.