Katherine A Clark, DO
Individual provider Active NPI Family Medicine Physician · Beavercreek, OH
NPI 1366424798 · NPPES record last updated Nov 25, 2020
Key facts
- NPI
- 1366424798
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 34004845 (OH)
- Practice address
- 4172 Indian Ripple Rd Ste a
Beavercreek, OH 45440-3286 - Phone
- (937) 431-3779
- Fax
- (937) 431-3776
- NPI assigned
- Nov 21, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Ohio University, College of Osteopathic Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Alliance Physicians Inc
Practice addresses (Care Compare)
1625 S Alex Rd
West Carrollton, OH 45449-5404
Phone (937) 865-0534
68 Darst Rd
Beavercreek, OH 45440-3442
Phone (937) 531-0132
Hospital & facility affiliations
- Kettering Health Dayton
- Kettering Health Main Campus
- Soin Medical Center
- Kettering Health Troy
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080804000554 | OH | Practitioner - Family Practice | 6002980349 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34004845 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alliance Physicians Inc | Family Medicine | Current |
Accepting new patients |
| Alliance Physicians Inc | Current |
Accepting new patients | |
| First Dayton Orthopedists, Inc. | Past | Accepting new patients |
Locations
3371 Kemp Rd
Beavercreek, OH 45431
Phone (937) 320-3600
4172 Indian Ripple Rd
Ste A
Dayton, OH 45440
Phone (937) 431-3779
7740 Washington Village Dr
Ste 130
Dayton, OH 45459
Phone (513) 932-4891
3535 Southern Blvd
Ste 4300
Kettering, OH 45429
Phone (937) 298-7332
2115 Leiter Rd
Ste 300
Miamisburg, OH 45342
2115 Leiter Rd
Miamisburg, OH 45342
Phone (937) 384-6920
1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306
1 Kettering Way
Ste 200
Piqua, OH 45356
Phone (937) 916-2700
1625 S Alex Rd
West Carrollton, OH 45449
Phone (937) 865-0534
1141 N Monroe Dr
Xenia, OH 45385
Phone (937) 352-2000
50 N Progress Dr
Xenia, OH 45385
Phone (937) 352-2850
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 34004845 | OH | Yes |
Addresses
Primary practice location
4172 Indian Ripple Rd Ste a
Beavercreek, OH 45440-3286
Mailing address
4172 Indian Ripple Rd Ste a
Beavercreek, OH 45440-3286
Phone (937) 431-3779
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0935368 | Medicaid | OH |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/ | ||
| Direct Messaging Address | kclark167096@direct.ketteringhealth.org |
Other providers in Beavercreek, OH
- Madison Grace Ciaramitaro
- Jacqueline Cinelli
- Luis Diego Clare
- Ella Rose Clark
- Jerry A Clark
- Katie Marie Clark
- Terra Renee Claybaugh
- Clear Horizons Counseling LLC
- Kari Clements
- Jonathan A Clifford
All providers in Beavercreek, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.