NPIMap

Individual provider Active NPI

Heidi Marie Clark, D.O.

  • Family Medicine Physician
  • Tunkhannock, PA
National Provider Identifier
1255321386
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS012488 Issued in PA
Practice address
10 Trieble Dr
Tunkhannock, PA 18657-7054
Phone
(570) 996-2700
Fax
(570) 996-2711
NPI assigned
Oct 28, 2005
Last updated
Aug 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS012488 PA Primary

Addresses

Primary practice location

10 Trieble Dr
Tunkhannock, PA 18657-7054

Mailing address

100 N Academy Ave
Credentials Dept
Danville, PA 17822-4903
Phone (570) 271-6144

Other identifiers 1

IdentifierTypeStateIssuer
1027140510001MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hclark101460@direct.geisinger.edu Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120618000124 PA Practitioner - Family Practice 3779511043 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

10 Trieble Dr
Tunkhannock, PA 18657-7054
Phone (570) 996-2700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS012488PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger-HM Joint Venture, LLC Family Medicine CurrentSince Dec 24, 2021 Accepting new patients
Geisinger-HM Joint Venture, LLC Family Medicine Current Accepting new patients
Geisinger Clinic Family Medicine Current Accepting new patients
Geisinger-HM Joint Venture, LLC Family Medicine CurrentSince Dec 24, 2021 Accepting new patients
Geisinger Clinic CurrentSince Jul 1, 2012 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

68 Spring St
Lock Haven, PA 17745
Phone (570) 263-5830

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

10 Trieble Dr
Tunkhannock, PA 18657
Phone (570) 836-2273

110 Trieble Dr
Ste 1
Tunkhannock, PA 18657
Phone (570) 996-2700

1824 E 3rd St
Williamsport, PA 17701
Phone (570) 322-4422

Interoperability endpoints

  • Direct secure messaging: hclark101460@direct.geisinger.edu

Organizations & group practices 6

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.

Hospital & facility affiliations 64

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1255321386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "address_2": "CREDENTIALS DEPT",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 TRIEBLE DR",
            "city": "TUNKHANNOCK",
            "state": "PA",
            "postal_code": "186577054",
            "telephone_number": "570-996-2700",
            "fax_number": "570-996-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "HEIDI",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-28",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS012488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027140510001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hclark101460@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "10 Trieble Dr",
            "city": "Tunkhannock",
            "state": "PA",
            "country_code": "US",
            "postal_code": "186577054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tunkhannock, PA

Sources for this page

Verify at the official NPI Registry.