Michael J Clark, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

27254 Issued in MN

Practice address

1720 Highway 59 S
Thief River Falls, MN 56701-4331

Phone

(218) 681-4747

Fax

(218) 683-2595

NPI assigned

Jul 3, 2006

Last updated

Mar 25, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Merit-based Incentive Payment System (MIPS)

Final score

90.22 of 100Reported as group

Quality

90.28

Promoting interoperability

100

Improvement activities

40

Cost

72.7

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mclark1841437@direct.sanfordhealth.org

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.

• Lifecare Medical Center

  • Critical Access Hospital
  • Roseau, MN
  • NPI 1609861095
  Medicare reassignment NPD
• Sanford Health Network North

  dba Sanford Thief River Falls Medical Center

  • Critical Access Hospital
  • Thief River Falls, MN
  • NPI 1043218753
  Medicare reassignment NPD
• Lakewood Health Center

  dba CHI Lakewood Health

  • Critical Access Hospital
  • Baudette, MN
  • NPI 1922072776
  Medicare reassignment
• Altru Health System

  dba Altru Care Flight

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD (past)
• Encompass Family Physician Medical Group

  • Family Medicine Physician
  • Spring Valley, CA
  • NPI 1720035744
  NPD (past)
• Sharpcare Medical Group, Apc

  • Family Medicine Physician
  • Coronado, CA
  • NPI 1730521568
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1215967898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 HIGHWAY 59 S",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567014331",
            "telephone_number": "218-681-4747",
            "fax_number": "218-683-2595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 HIGHWAY 59 S",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567014331",
            "telephone_number": "218-681-4747",
            "fax_number": "218-683-2595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "27254",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "5746",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS #",
            "identifier": "507S2CL",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "564508500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO/ARAZ #",
            "identifier": "2441653",
            "state": "FM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mclark1841437@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "1720 Highway 59 S",
            "city": "Thief River Falls",
            "state": "MN",
            "country_code": "US",
            "postal_code": "567014331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Duane C Browning, MD
• Morghan Jo Bugge
• Stacy Mae Carlson
• Thomas Carson, PT, DPT
• Eloise Marie Clark, MD
• Connected Kids Therapy LLC
• Hugh Ben Cowan, MD
• Dakota Clinic LTD (Dakota Clinic Ambulatory Surgery Center)
• Dakota Clinic LTD (Dakota Clinic LTD Thief River Falls)
• Dakota Clinic TRF Pharmacy

• Family Medicine Physician in Thief River Falls, MN
• Providers in Thief River Falls, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; 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.
• 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.