Samuel David Clark, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

N4354 Issued in TX

Practice address

120 Hillcrest Medical Blvd
Suite 200
Waco, TX 76712-8948

Phone

(254) 297-0400

NPI assigned

Jan 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sclark13198@direct.sw.org

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.

• Scott & White Clinic

  • Internal Medicine Physician
  • Temple, TX
  • NPI 1093779704

  Pediatrics

  Medicare reassignment NPD
• Scott & White Clinic

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1649820796

  Pediatrics

  NPD
• Hillcrest Baptist Medical Center

  • General Acute Care Hospital
  • Waco, TX
  • NPI 1891882833
  NPD (past)

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

{
    "created_epoch": "1168646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1346391752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 HILLCREST MEDICAL BLVD",
            "address_2": "SUITE 200",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767128948",
            "telephone_number": "254-297-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HILLCREST MEDICAL BLVD",
            "address_2": "SUITE 200",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767128948",
            "telephone_number": "254-297-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SAMUEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "N4354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sclark13198@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "120 Hillcrest Medical Blvd",
            "address_2": "Suite 200",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767128948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kathleen Clark
• Leslie Joy Clark, LMSW
• Madalynn Cheri Clark
• Madison Clark
• Rebecca Clark
• Stephanie Renae Classen, M.S. LMFT
• Stephanie Elise Claus, MD
• Morgan Claxton, PT
• Clayton F Watkins II, LPC, PC
• Clear Flame Counseling, PLLC

• Pediatrics Physician in Waco, TX
• Providers in Waco, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.