Katelyn Ann Clark, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD175116 Issued in OR

Practice address

Peacehealth Surgical Specialties
3355 Riverbend Dr., Suite 300
Springfield, OR 97477

Phone

(541) 222-8333

Fax

(541) 222-8320

NPI assigned

Apr 19, 2011

Sex

Female

Sole proprietor

Yes

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

Enrolled in OR

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

Specialty

General Surgery

Education

Oregon Health Sciences University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Peacehealth Medical GroupGroup PAC ID 9032023270, 256 clinicians

PeacehealthGroup PAC ID 8527016039, 200 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102
• Bay Area Hospital Hospital, Coos Bay, OR, CCN 380090

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kclar110@yourcarecommunity.org
• Direct secure messaging: kclark261789@direct.peacehealth.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.

• Peacehealth

  • Hospitalist Physician
  • Springfield, OR
  • NPI 1740223874

  Surgery

  Medicare reassignment Care Compare group NPD
• Peacehealth Medical Group

  • Family Medicine Physician
  • Eugene, OR
  • NPI 1447207287

  Surgery

  Medicare reassignment Care Compare group NPD
• Peacehealth Medical Group

  • Birthing Clinic/Center
  • Springfield, OR
  • NPI 1881860856
  NPD
• Peacehealth

  • General Acute Care Hospital
  • Springfield, OR
  • NPI 1083888515
  NPD (past)

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

• Bay Area Hospital District

  • General Acute Care Hospital
  • Coos Bay, OR
  • NPI 1225016561
  Care Compare affiliation
• Peacehealth

  • General Acute Care Hospital
  • Springfield, OR
  • NPI 1083888515
  Care Compare affiliation
• Peacehealth

  • Psychiatric Hospital Unit
  • Eugene, OR
  • NPI 1568236974
  Care Compare affiliation

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1366732729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PEACEHEALTH SURGICAL SPECIALTIES",
            "address_2": "3355 RIVERBEND DR., SUITE 300",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "97477",
            "telephone_number": "541-222-8333",
            "fax_number": "541-222-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PEACEHEALTH SURGICAL SPECIALTIES",
            "address_2": "3355 RIVERBEND DR., SUITE 300",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "97477",
            "telephone_number": "541-222-8333",
            "fax_number": "541-222-8320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3377 Riverbend Dr Ste 230",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "974778806",
            "country_code": "US",
            "telephone_number": "541-222-2700",
            "fax_number": "541-222-6113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATELYN",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-19",
        "last_updated": "2024-02-28",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD175116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500654943",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Albert Wayne Clark Jr.
• Brandon Clark
• David A Clark, DO
• Gail Marie Clark, LPN
• Joshua Clark, M.D.
• Taylor J Clarke, LMT
• Jennifer Amy Clason, RN
• Charlotte Ann Clausen, MD
• George R Clayton, RPH
• Tami Clayton, MS

• Surgery Physician in Springfield, OR
• Providers in Springfield, OR by specialty
• Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.