NPIMap

Individual provider Active NPI

Lowell F. Clark, M.D.

  • Internal Medicine Physician
  • Bushnell, FL
National Provider Identifier
1336103563
Registry record updated Dec 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0045090 Issued in FL
Practice address
212 S Florida St
Bushnell, FL 33513-6703
Phone
(352) 793-2441
Fax
(352) 793-3282
NPI assigned
Apr 14, 2006
Last updated
Dec 21, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0045090 FL Primary

Addresses

Primary practice location

212 S Florida St
Bushnell, FL 33513-6703

Mailing address

212 S Florida St
Bushnell, FL 33513-6703
Phone (352) 793-2441

Other identifiers 1

IdentifierTypeStateIssuer
35207OtherFLBCBS PROVIDER ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20040813000539 FL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 3577473982 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lowell F. Clark MD PAGroup PAC ID 7416918370, 31 clinicians

Practice addresses (Care Compare)

110 Lodge Terrace Dr
Altoona, FL 32702-9668
Phone (352) 787-1600

212 S Florida St
Bushnell, FL 33513-6703
Phone (352) 793-2441

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Clark LTC PA Internal Medicine Current Accepting new patients
Clark Clinic Inc PastSince Oct 9, 2002 Accepting new patients
Lowell F Clark MD PA Past Accepting new patients
Clark Clinic Inc Internal Medicine Past Accepting new patients
Lowell F. Clark MD PA Past Accepting new patients
Clark Clinic Inc Past Accepting new patients
Lowell F Clark MD PA Internal Medicine Past Accepting new patients
Lowell F Clark MD PA Internal Medicine Past Accepting new patients
Clark Clinic Inc Past Accepting new patients
Clark Clinic Inc Past Accepting new patients
Clark Clinic Inc Past Accepting new patients
Lowell F Clark MD PA Internal Medicine Past Accepting new patients
Clark Clinic Inc Past Accepting new patients

Locations

212 S Florida St
Bushnell, FL 33513
Phone (352) 793-2441

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: lclark562485@direct.shands.ufl.edu

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lakeview Terrace Rehabilitation and Health Care CenterAltoona, FL, CCN 106068 Skilled nursing facility Adp of the SNF Jun 1, 2018
Osprey Point Nursing CenterBushnell, FL, CCN 106008 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2024
Feb 20, 2025
Clark Clinic IncHowey in the Hills, FL, CCN 108973 Rural health clinic 5% Or Greater Direct Ownership Interest
Corporate Director		 Oct 9, 2003
Mar 1, 2004
Clark Clinic IncBushnell, FL, CCN 108972 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Corporate Officer (50%)		 Oct 9, 2002
Oct 9, 2002
Clark Clinic IncMascotte, FL, CCN 683832 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
W-2 Managing Employee (100%)		 Aug 1, 2017
Aug 1, 2017
Clark Clinic IncSan Antonio, FL, CCN 683849 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
W-2 Managing Employee (100%)		 Jul 1, 2021
Jul 1, 2021

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198195200000",
    "number": "1336103563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S FLORIDA ST",
            "city": "BUSHNELL",
            "state": "FL",
            "postal_code": "335136703",
            "telephone_number": "352-793-2441",
            "fax_number": "352-793-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S FLORIDA ST",
            "city": "BUSHNELL",
            "state": "FL",
            "postal_code": "335136703",
            "telephone_number": "352-793-2441",
            "fax_number": "352-793-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LOWELL",
        "middle_name": "F.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2007-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0045090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "35207",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bushnell, FL

Sources for this page

Verify at the official NPI Registry.