Active NPI
Michael Ellsworth Clarke, DDS MS
- Oral & Maxillofacial Surgery (D.M.D.)
- Wailuku, HI
National Provider Identifier
1316908296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)
- License
- DT1439
- Practice address
- 24 N Church St
#206
Wailuku, HI 96795 - Phone
- (808) 242-0077
- Fax
- (808) 243-8007
- NPI assigned
- Mar 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | DT1439 | HI | Primary |
Addresses
Primary practice location
24 N Church St
#206
Wailuku, HI 96795
Mailing address
24 N Church St
#206
Wailuku, HI 96795
Phone (808) 242-0077
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1439 | Other | HI | HDS |
| 52622001 | Medicaid | HI | |
| B059978 | Other | HMSA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Aug 16, 2018 through Aug 16, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316908296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 N CHURCH ST",
"address_2": "#206",
"city": "WAILUKU",
"state": "HI",
"postal_code": "96795",
"telephone_number": "808-242-0077",
"fax_number": "808-243-8007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 N CHURCH ST",
"address_2": "#206",
"city": "WAILUKU",
"state": "HI",
"postal_code": "96795",
"telephone_number": "808-242-0077",
"fax_number": "808-243-8007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "MICHAEL",
"middle_name": "ELLSWORTH",
"name_prefix": "Dr.",
"credential": "DDS MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "HI",
"license": "DT1439",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HDS",
"identifier": "1439",
"state": "HI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52622001",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA",
"identifier": "B059978",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Wailuku, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.