NPIMap

Individual provider Active NPI

Christopher D Clark, MD

  • Emergency Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1336436054
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4301098458 Issued in MI
Practice address
1000 Monroe Ave NW
Grand Rapids, MI 49503-1455
Phone
(616) 732-6200
NPI assigned
Jul 1, 2011
Last updated
Jan 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301098458 MI
Emergency Medicine Physician 207P00000X 4301098458 MI Primary

Addresses

Primary practice location

1000 Monroe Ave NW
Grand Rapids, MI 49503-1455

Mailing address

4100 Embassy Dr SE Ste 400
Grand Rapids, MI 49546-2416

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20140127000513 MI Practitioner - Emergency Medicine 2961630835 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Toledo Medical College, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ecs Western Michigan PCGroup PAC ID 8628327384, 202 clinicians
Memorial HospitalGroup PAC ID 8527976497, 210 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560
Phone (616) 391-1680

826 W King St
Memorial Medical Associates
Owosso, MI 48867-2120
Phone (989) 723-5211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.48 of 100Reported as group
Quality
89.26
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.11 of 100Reported as group
Quality
81.85
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301098458MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital Anesthesiology CurrentSince Dec 1, 2020 Accepting new patients
Visionary Medical Services PC Anesthesiology CurrentSince Mar 15, 2019 Accepting new patients
Memorial Hospital Anesthesiology CurrentSince Dec 1, 2020 Accepting new patients
Emergency Professionals of Michigan, P.C. Emergency Medicine CurrentSince Dec 30, 2016 Accepting new patients
Ecs Western Michigan PC Anesthesiology CurrentSince Aug 1, 2018 Accepting new patients

Locations

7300 N Canton Center Rd
Canton, MI 48187
Phone (734) 454-8001

9000 Peet Rd
Chesaning, MI 48616
Phone (989) 720-2273

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

615 S Bower St
Greenville, MI 48838
Phone (616) 754-4341

826 W King St
Owosso, MI 48867
Phone (989) 720-2273

3337 Britton Rd
Perry, MI 48872
Phone (517) 625-3004

8333 Felch St
Ste 200
Zeeland, MI 49464
Phone (616) 748-2850

Organizations & group practices 5

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 4

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": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1336436054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 EMBASSY DR SE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MONROE AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031455",
            "telephone_number": "616-732-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-01",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301098458",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301098458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.