Matthew Alexander Clark, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

39323 Issued in CO

Practice address

Ute Mountain Ute Health Center
Complex B Rustling Willow Street
Towaoc, CO 81334-0049

Phone

(970) 565-4441

NPI assigned

Apr 26, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Southern Colorado Ute Service Unit

  • Federal Public Health Clinic/Center
  • Towaoc, CO
  • NPI 1255422788

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254700800000",
    "number": "1215993308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 49",
            "city": "TOWAOC",
            "state": "CO",
            "postal_code": "813340049",
            "telephone_number": "970-565-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UTE MOUNTAIN UTE HEALTH CENTER",
            "address_2": "COMPLEX B RUSTLING WILLOW STREET",
            "city": "TOWAOC",
            "state": "CO",
            "postal_code": "813340049",
            "telephone_number": "970-565-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MATTHEW",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2009-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "39323",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "39323",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "24857751",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roberto Baca, RN
• Trina Bancroft-Begay, MD
• Nancy Louise Cole, RN
• Ruby Doyle, R.N.
• Lisa Colleen Fitzpatrick, RDH
• Susan Fredrickson, PH.D.
• Richard L Harland Jr., BS, CAS

• All providers in Towaoc, CO
• Internal Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.