James A Clark, CADCIII

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

484 Issued in WI

Practice address

509 McMillen St
Fort Atkinson, WI 53538-1263

Phone

(920) 563-7995

Fax

(920) 568-6047

NPI assigned

Jul 26, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/

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.

• Fort Healthcare Inc

  • Rural Health Clinic/Center
  • Fort Atkinson, WI
  • NPI 1417450115
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356365316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MCMILLEN ST",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381263",
            "telephone_number": "920-563-7995",
            "fax_number": "920-568-6047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MCMILLEN ST",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381263",
            "telephone_number": "920-563-7995",
            "fax_number": "920-568-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JAMES",
        "middle_name": "A",
        "credential": "CADCIII",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39344700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joyce Rene Christensen, RN
• Christine A Chuppa, M.D.
• Jeffrey A Cichocki, CRNA
• Laura K. Cichocki, CRNA
• City of Fort Atkinson
• Luann S Clark, RN
• Michael Anthony Coletta, RPH
• Colleen a. Mitchell Psychological Services
• Clark A Collins, PA-C
• C. Sue Conley, M.D.

• Addiction (Substance Use Disorder) Counselor in Fort Atkinson, WI
• Providers in Fort Atkinson, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.