Diana L Clark, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01029421A Issued in IN

Practice address

701 E County Line Rd Ste 301
Greenwood, IN 46143-1071

Phone

(317) 883-4736

Fax

(317) 859-1576

NPI assigned

Aug 4, 2005

Last updated

Jul 2, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1123113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404259200000",
    "number": "1225039860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E COUNTY LINE RD STE 301",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431071",
            "telephone_number": "317-883-4736",
            "fax_number": "317-859-1576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E COUNTY LINE RD STE 301",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431071",
            "telephone_number": "317-883-4736",
            "fax_number": "317-859-1576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DIANA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-04",
        "last_updated": "2014-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01029421A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200224710",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blake Christy, DO
• Olivia Chubb
• Kyle B Ciresi, MSW, LCSW, LCAC
• Donna Cisco, LCSW, LCAC
• Christopher William Clark, PA-C
• Haley R Clark
• Jasmine Clark, RBT
• Jordan Lee Clark, PHARMD
• Kelly Lynn Clark, PT
• Miranda Clark, FNP-C

• Family Medicine Physician in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.