Shannon Clark, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A103021 Issued in CA

Practice address

4860 Y St
Suite 2500
Sacramento, CA 95817-2307

Phone

(916) 734-8445

Fax

(916) 734-6666

NPI assigned

Sep 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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

Merit-based Incentive Payment System (MIPS)

Final score

83.15 of 100Reported as group

Quality

64.8

Promoting interoperability

100

Improvement activities

40

Cost

68.65

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• County of San Joaquin

  • General Acute Care Hospital
  • French Camp, CA
  • NPI 1801830583
  Medicare reassignment NPD
• Regents of the Univ of Ca

  • Maternal & Fetal Medicine Physician
  • Sacramento, CA
  • NPI 1013906973
  Medicare reassignment NPD
• San Joaquin Faculty Medical Group

  • Internal Medicine Physician
  • French Camp, CA
  • NPI 1225063761
  Medicare reassignment NPD
• County of San Joaquin

  • Multi-Specialty Clinic/Center
  • Manteca, CA
  • NPI 1417407636
  NPD
• Regents of the Univ of Ca

  • Infectious Disease Physician
  • Sacramento, CA
  • NPI 1437142452
  NPD
• Regents of the Univ of Ca

  • Diagnostic Radiology Physician
  • Sacramento, CA
  • NPI 1477546406
  NPD
• Regents of the Univ of Ca

  • Surgery Physician
  • Sacramento, CA
  • NPI 1427041698
  NPD (past)
• Regents of the Univ of Ca

  • Pulmonary Disease Physician
  • Sacramento, CA
  • NPI 1437142692
  NPD (past)

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342483200000",
    "number": "1295922912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4860 Y ST",
            "address_2": "SUITE 2500",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172307",
            "telephone_number": "916-734-8445",
            "fax_number": "916-734-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4860 Y ST",
            "address_2": "SUITE 2500",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172307",
            "telephone_number": "916-734-8445",
            "fax_number": "916-734-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-26",
        "last_updated": "2012-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A103021",
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "CA",
            "license": "A103021",
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "CA",
            "license": "A103121",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "00000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nichol Clark
• Richard Patterson Clark, MD
• Robin Kaye Clark, OTR/L
• Scott D. Clark, B.A.
• Seven B Clark
• Stephanie Clark, RN
• Tierra Morgan Clark
• Tonya Elaine Clark, RDHAP
• Darcy Sullivan Clarke, LPCC, CADC-II
• Dawn Kimberly Clarke, PSYD

• Family Medicine Physician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; 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.